Organization
FIVE-TOWN HEALTH ALLIANCE, INC
Active
Parent organization
FIVE-TOWN HEALTH ALLIANCE, INC
Other names
Mountain Health Center, Mountain Community Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
FIVE-TOWN HEALTH ALLIANCE, INC
Authorized official
HEIDI MELBOSTAD MD (CEO)
(802) 453-3911
Entity
Organization
Contact information
Practice address
61 PINE ST, BRISTOL, VT 05443-1043
(802) 453-3911
(802) 453-6105
Mailing address
61 PINE ST BLDG 4, BRISTOL, VT 05443-1043
(802) 453-5028
(802) 453-6105
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0029894
MEDICARE PART B
VT
05
—
0471846
—
VT
05
—
1021079
—
VT
01
—
471846
MEDICARE PART A FQHC
VT
Enumeration date
08/09/2012
Last updated
08/27/2025
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