Healthcare Provider Details

I. General information

NPI: 1104400563
Provider Name (Legal Business Name): MH HEALTH CARE SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2985 AMES CROSSING RD
EAGAN MN
55121-2498
US

IV. Provider business mailing address

20 WINOOSKI FALLS WAY STE 400
WINOOSKI VT
05404-2239
US

V. Phone/Fax

Practice location:
  • Phone: 802-857-0400
  • 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: DR. TERRY LAYMAN
Title or Position: CORPORATE MEDICAL OFFICER
Credential: MD
Phone: 317-727-6898