Provider Demographics
NPI:1528620838
Name:FIVE-TOWN HEALTH ALLIANCE, INC
Entity type:Organization
Organization Name:FIVE-TOWN HEALTH ALLIANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-453-5116
Mailing Address - Street 1:74 MUNSILL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-1047
Mailing Address - Country:US
Mailing Address - Phone:802-453-5028
Mailing Address - Fax:
Practice Address - Street 1:56 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1447
Practice Address - Country:US
Practice Address - Phone:802-453-5028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE-TOWN HEALTH ALLIANCE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty