1952852956 NPI number — MID-STATE HEALTH CENTER

Table of content: (NPI 1952852956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952852956 NPI number — MID-STATE HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID-STATE HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952852956
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 BOULDER POINT DR STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03264-3170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 TENNEY MOUNTAIN HWY STE 144
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03264-3156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-536-4000
Provider Business Practice Location Address Fax Number:
603-536-4001
Provider Enumeration Date:
10/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SWEENEY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
ALBERT
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
603-238-3502

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 301817 . This is a "MEDICARE FQHC NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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