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General NPI Number Information
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NPI Number | 1134508443
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Entity Type | Organization
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Legal Business Name | MH HEALTH CARE SERVICES, PC
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 415 W COLLINS RD C/O BAF EMPLOYEE HEALTH CENTER
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City | BLACKFOOT
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State | ID
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Zip | 83221-5642
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Country | US
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Telephone | 802-857-0400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5
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City | WINOOSKI
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State | VT
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Zip | 05404-0005
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Country | US
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Telephone | 802-857-0400
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NANCY CARLSON
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Credential | M.D.
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Telephone | 802-857-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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