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General NPI Number Information
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NPI Number | 1245997584
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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 | 11/22/2021
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 101 BOULDER POINT DR STE 3
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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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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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