Healthcare Provider Details

I. General information

NPI: 1003939463
Provider Name (Legal Business Name): MOUNTAIN HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MOUNTAIN ST
BRISTOL VT
05443-1310
US

IV. Provider business mailing address

30 MOUNTAIN ST
BRISTOL VT
05443-1310
US

V. Phone/Fax

Practice location:
  • Phone: 802-453-5028
  • Fax: 802-453-6105
Mailing address:
  • Phone: 802-453-5028
  • Fax: 802-453-6105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA A HANF
Title or Position: OFFICE MANAGER
Credential:
Phone: 802-453-5028