Organization
MID-STATE HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT MACLEOD (CEO)
(603) 536-4000
Entity
Organization
Contact information
Practice address
100 ROBIE ROAD, BRISTOL, NH 03222-4506
(603) 744-6200
(603) 536-4001
Mailing address
101 BOULDER POINT DRIVE, SUITE 1, PLYMOUTH, NH 03264
(603) 536-4000
(603) 536-4001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30009302
—
NH
05
—
30514289
—
NH
05
—
3070980
—
NH
Enumeration date
03/22/2007
Last updated
07/27/2021
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