Provider Demographics
NPI:1295756476
Name:BEDFORD WOMEN'S CARE ASSOCIATES PA
Entity type:Organization
Organization Name:BEDFORD WOMEN'S CARE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-647-0494
Mailing Address - Street 1:160 S RIVER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6927
Mailing Address - Country:US
Mailing Address - Phone:603-647-0494
Mailing Address - Fax:603-647-0493
Practice Address - Street 1:160 S RIVER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6927
Practice Address - Country:US
Practice Address - Phone:603-647-0494
Practice Address - Fax:603-647-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30211208Medicaid
NH30211208Medicaid