Provider Demographics
NPI: | 1407502180 |
---|---|
Name: | MH HEALTH CARE SERVICES, PC |
Entity type: | Organization |
Organization Name: | MH HEALTH CARE SERVICES, PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SR VICE PRESIDENT CORPORATE MEDICAL |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | TERRY |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | LAYMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 317-522-0844 |
Mailing Address - Street 1: | 20 WINOOSKI FALLS WAY STE 400 |
Mailing Address - Street 2: | |
Mailing Address - City: | WINOOSKI |
Mailing Address - State: | VT |
Mailing Address - Zip Code: | 05404-2239 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4838 12TH STREET EXT STE C |
Practice Address - Street 2: | |
Practice Address - City: | WEST COLUMBIA |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29172-3028 |
Practice Address - Country: | US |
Practice Address - Phone: | 803-573-2161 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | MH HEALTH CARE SERVICES, PC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2022-02-22 |
Last Update Date: | 2022-02-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty |