Healthcare Provider Details

I. General information

NPI: 1437542172
Provider Name (Legal Business Name): MH HEALTH CARE SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E HINTZ RD C/O LAKE REGION EMPLOYEE HEALTH CENTER
WHEELING IL
60090-6044
US

IV. Provider business mailing address

PO BOX 5
WINOOSKI VT
05404-0005
US

V. Phone/Fax

Practice location:
  • Phone: 847-325-9630
  • Fax:
Mailing address:
  • Phone: 802-857-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MS. NANCY CARLSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 802-857-0400