Active NPI
Berwick Family Health Center LLC
- Family Medicine Physician
- Laconia, NH
National Provider Identifier
1689903007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 1276
- Legal business name
- BERWICK FAMILY HEALTH CENTER LLC
- Practice address
- 36 Endicott
Laconia, NH 03246 - Phone
- (603) 366-7700
- Fax
- (603) 366-7775
- NPI assigned
- Dec 14, 2009
- Last updated
- Dec 14, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Bradley N Libenson, DO
- Title
- Owner and Provider
- Phone
- (207) 698-7900
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 1276 | ME | Primary |
Addresses
Primary practice location
36 Endicott
Laconia, NH 03246
Mailing address
PO Box 719
Berwick, ME 03901-0719
Phone (207) 698-7900
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30202194 | Medicaid | NH | |
| 174580000 | Medicaid | ME |
National Provider Directory
National Provider Directory- Tax ID family
- Berwick Family Health Center LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Family Medicine Physician
- Berwick, ME
- NPI 1558431460
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Family Medicine Physician
- Berwick, ME
- NPI 1548339849
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260748800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1260748800000",
"number": "1689903007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 719",
"city": "BERWICK",
"state": "ME",
"postal_code": "039010719",
"telephone_number": "207-698-7900",
"fax_number": "207-698-7977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 ENDICOTT",
"city": "LACONIA",
"state": "NH",
"postal_code": "03246",
"telephone_number": "603-366-7700",
"fax_number": "603-366-7775"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BERWICK FAMILY HEALTH CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2009-12-14",
"last_updated": "2009-12-14",
"status": "A",
"authorized_official_last_name": "LIBENSON",
"authorized_official_first_name": "BRADLEY",
"authorized_official_middle_name": "N",
"authorized_official_title_or_position": "OWNER AND PROVIDER",
"authorized_official_telephone_number": "207-698-7900",
"authorized_official_credential": "DO"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ME",
"license": "1276",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30202194",
"state": "NH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "174580000",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Laconia, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.