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General NPI Number Information
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NPI Number | 1871840843
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Entity Type | Organization
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Legal Business Name | FIVE-TOWN HEALTH ALLIANCE, INC
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 61 PINE ST
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City | BRISTOL
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State | VT
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Zip | 05443-1043
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Country | US
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Telephone | 802-453-3911
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Fax | 802-453-6105
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Provider Business Mailing Address
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Address Line | 61 PINE ST BLDG 4
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City | BRISTOL
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State | VT
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Zip | 05443-1043
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Country | US
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Telephone | 802-453-5028
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Fax | 802-453-6105
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Authorized Official
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Title or Position | CEO
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Name | HEIDI MELBOSTAD
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Credential | MD
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Telephone | 802-453-3911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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 | VT
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