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General NPI Number Information
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NPI Number | 1144069758
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Entity Type | Organization
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Legal Business Name | MID-STATE HEALTH CENTER
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 393 HIGH ST
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City | GLENCLIFF
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State | NH
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Zip | 03238
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Country | US
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Telephone | 603-536-4000
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Fax | 603-536-4001
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Provider Business Mailing Address
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Address Line | 101 BOULDER POINT DR STE 1
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City | PLYMOUTH
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State | NH
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Zip | 03264-3170
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Country | US
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Telephone | 603-536-4000
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Fax | 603-536-4001
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Authorized Official
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Title or Position | CEO
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Name | ROBERT MACLEOD
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Credential |
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Telephone | 603-536-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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