Healthcare Provider Details

I. General information

NPI: 1316260631
Provider Name (Legal Business Name): MH HEALTH CARE SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 MOUNTAIN VIEW DR SUITE 300
COLCHESTER VT
05446-5968
US

IV. Provider business mailing address

4509 W STONE DR C/O BAE HEALTH CLINIC
KINGSPORT TN
37660-1048
US

V. Phone/Fax

Practice location:
  • Phone: 802-857-0400
  • Fax: 802-655-3607
Mailing address:
  • Phone: 423-578-6484
  • Fax: 423-578-6485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

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