Organization
COOS COUNTY FAMILY HEALTH SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH GORDON (CEO)
(603) 752-3669
Entity
Organization
Contact information
Practice address
2 BROADWAY AVE, GORHAM, NH 03581-1502
(603) 466-2741
(603) 466-2953
Mailing address
133 PLEASANT ST, BERLIN, NH 03570-2006
(603) 752-2040
(603) 752-7797
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NH
207R00000X
Internal Medicine Physician
—
NH
208000000X
Pediatrics Physician
—
NH
213E00000X
Podiatrist
—
NH
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363AM0700X
Medical Physician Assistant
—
NH
363LF0000X
Family Nurse Practitioner
—
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3007254
—
NH
01
—
5830418
AETNA
—
01
—
788438
MVP HEALTHCARE
—
05
—
99908646
—
NH
01
—
CN7051
MEDICARE RAILROAD
—
Enumeration date
08/12/2005
Last updated
09/17/2020
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