Healthcare Provider Details

I. General information

NPI: 1871840843
Provider Name (Legal Business Name): FIVE-TOWN HEALTH ALLIANCE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 PINE ST
BRISTOL VT
05443-1043
US

IV. Provider business mailing address

61 PINE ST BLDG 4
BRISTOL VT
05443-1043
US

V. Phone/Fax

Practice location:
  • Phone: 802-453-3911
  • Fax: 802-453-6105
Mailing address:
  • Phone: 802-453-5028
  • Fax: 802-453-6105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateVT

VIII. Authorized Official

Name: HEIDI MELBOSTAD
Title or Position: CEO
Credential:
Phone: 858-344-1912