Healthcare Provider Details

I. General information

NPI: 1063847317
Provider Name (Legal Business Name): MH HEALTH CARE SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7135 W SAHARA AVE STE 100 C/O LABORERS HEALTH CENTER
LAS VEGAS NV
89117-2828
US

IV. Provider business mailing address

PO BOX 5
WINOOSKI VT
05404-0005
US

V. Phone/Fax

Practice location:
  • Phone: 702-222-9355
  • Fax:
Mailing address:
  • Phone: 802-857-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number042-0008079
License Number StateVT

VIII. Authorized Official

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