Provider Demographics
NPI:1104059237
Name:ORION DIAGNOSTICS INCORPORATED
Entity type:Organization
Organization Name:ORION DIAGNOSTICS INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:BISSELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:603-863-9605
Mailing Address - Street 1:P.O. BOX 25
Mailing Address - Street 2:138 ELM STREET
Mailing Address - City:NEWPORT
Mailing Address - State:NH
Mailing Address - Zip Code:03773-0025
Mailing Address - Country:US
Mailing Address - Phone:603-863-1260
Mailing Address - Fax:603-863-0750
Practice Address - Street 1:138 ELM STREET
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773-0025
Practice Address - Country:US
Practice Address - Phone:603-863-1260
Practice Address - Fax:603-863-0750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X, 104100000X
NH1303101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty