# MID-STATE HEALTH CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912166083
- **Authorized official:** ROBERT MACLEOD (CEO)
- **Authorized official phone:** (603) 536-4000

## Contact information

- **Practice address:** 100 ROBIE ROAD, BRISTOL, NH 03222-4506
- **Practice address phone:** (603) 744-6200
- **Practice address fax:** (603) 744-9024
- **Mailing address:** 101 BOULDER POINT DR, SUITE 1, PLYMOUTH, NH 03264-3170
- **Mailing address phone:** (603) 536-4000
- **Mailing address fax:** (603) 536-4001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/04/2008
- **Last updated:** 07/27/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 30009302 | — | NH |
| 01 | — | 301817 | MEDICARE PART A PLYMOUTH | NH |
| 01 | — | 301818 | MEDICARE PART A BRISTOL | NH |
| 05 | — | 3117469 | — | NH |