Provider Demographics
NPI:1003939463
Name:MOUNTAIN HEALTH CENTER
Entity Type:Organization
Organization Name:MOUNTAIN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-453-5028
Mailing Address - Street 1:30 MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-1310
Mailing Address - Country:US
Mailing Address - Phone:802-453-5028
Mailing Address - Fax:802-453-6105
Practice Address - Street 1:30 MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-1310
Practice Address - Country:US
Practice Address - Phone:802-453-5028
Practice Address - Fax:802-453-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty