Provider Demographics
NPI:1952852956
Name:MID-STATE HEALTH CENTER
Entity Type:Organization
Organization Name:MID-STATE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MBA
Authorized Official - Phone:603-238-3502
Mailing Address - Street 1:101 BOULDER POINT DR STE 1
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-3170
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:607 TENNEY MOUNTAIN HWY STE 144
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3156
Practice Address - Country:US
Practice Address - Phone:603-536-4000
Practice Address - Fax:603-536-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH301817OtherMEDICARE FQHC NUMBER