Organization
INDIAN STREAM HEALTH CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN W. BROWN (CEO)
(603) 388-2426
Entity
Organization
Contact information
Practice address
141 CORLISS LANE, COLEBROOK, NH 03576
(603) 237-8336
(603) 237-4467
Mailing address
141 CORLISS LANE, COLEBROOK, NH 03576
(603) 237-8336
(603) 237-4467
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
NH
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00068661
BCBS OF VT
VT
05
—
1011463
—
VT
01
—
200010975
MVP
NH
05
—
30213617
—
NH
05
—
30513983
—
NH
01
—
7459647
AETNA
NH
05
—
8000921
—
VT
01
—
8190651
CIGNA
NH
Enumeration date
07/03/2006
Last updated
01/27/2015
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