Provider Demographics
NPI:1659470383
Name:WHITE MOUNTAIN COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:WHITE MOUNTAIN COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-447-8900
Mailing Address - Street 1:PO BOX 2800
Mailing Address - Street 2:298 WHITE MOUNTAIN HIGHWAY
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-2800
Mailing Address - Country:US
Mailing Address - Phone:603-447-8900
Mailing Address - Fax:603-447-4846
Practice Address - Street 1:298 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818
Practice Address - Country:US
Practice Address - Phone:603-447-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH251B00000X, 261QA0005X, 261QD0000X, 261QF0400X, 261QM1300X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251B00000XAgenciesCase Management
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30901072Medicaid
NH82370289Medicaid
ME139970000Medicaid
NH=========OtherANTHEM BCBSNH
NH=========OtherCOMMERICAL INSURANCE