NPIMap

Individual provider Active NPI

Bruce D Latham, D.O.

  • Family Medicine Physician
  • Conway, NH
National Provider Identifier
1356302491
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12799 Issued in NH
Practice address
66 Main St
Conway, NH 03818-6163
Phone
(603) 901-1042
Fax
(603) 901-1092
NPI assigned
Mar 29, 2006
Last updated
Jul 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 12799 NH Primary

Addresses

Primary practice location

66 Main St
Conway, NH 03818-6163

Mailing address

PO Box 123
Conway, NH 03818-0123
Phone (603) 901-1042

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH, VT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050621000125 NH Practitioner - Family Practice 6305881467 Practice locations: Conway, NH
I20150619002322 VT Practitioner - Osteopathic Manipulative Medicine 6305881467 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Nova Southeastern Univ College of Dental Medicine, 1991
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

66 Main St
Conway, NH 03818-6163
Phone (603) 901-1042

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
12799NHMDFamily Medicine Physician
0069NHMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Bruce D. Latham, D.O.,P.a. Family Medicine CurrentSince Jan 1, 1990 Accepting new patients
Northeast Kingdom Hematology Oncology PLLC CurrentSince Nov 18, 2014 Accepting new patients
The Lakes Region Mental Health Center, Inc. PastSince Sep 24, 2009 Accepting new patients
Healthfirst Family Care Center, Inc. Past Accepting new patients

Locations

66 Main St
Conway, NH 03818
Phone (603) 447-2323

685 White Mountain Hwy
Tamworth, NH 03886
Phone (603) 323-2089

637 Union St
Newport, VT 05855
Phone (802) 334-4111

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1356302491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 123",
            "city": "CONWAY",
            "state": "NH",
            "postal_code": "038180123",
            "telephone_number": "603-901-1042",
            "fax_number": "603-901-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 MAIN ST",
            "city": "CONWAY",
            "state": "NH",
            "postal_code": "038186163",
            "telephone_number": "603-901-1042",
            "fax_number": "603-901-1092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATHAM",
        "first_name": "BRUCE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NH",
            "license": "12799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, NH

Sources for this page

Verify at the official NPI Registry.