Provider Demographics
NPI:1245997584
Name:MID-STATE HEALTH CENTER
Entity type:Organization
Organization Name:MID-STATE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MACLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-536-4000
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:603-536-4000
Mailing Address - Fax:603-536-4001
Practice Address - Street 1:101 BOULDER POINT DR STE 3
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3170
Practice Address - Country:US
Practice Address - Phone:603-536-4000
Practice Address - Fax:603-536-4001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-STATE HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty