Provider Demographics
NPI:1114322666
Name:MID-STATE HEALTH CENTER
Entity type:Organization
Organization Name:MID-STATE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-536-4000
Mailing Address - Street 1:101 BOULDER POINT DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-3170
Mailing Address - Country:US
Mailing Address - Phone:603-856-1728
Mailing Address - Fax:
Practice Address - Street 1:101 BOULDER POINT DR
Practice Address - Street 2:SUITE 1
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3170
Practice Address - Country:US
Practice Address - Phone:603-856-1728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH058640-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty