Basic Information
| Provider Information | |||||||||
| NPI: | 1952773871 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MH HEALTH CARE SERVICES, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MH HEALTH CARE SERVICES AT GW | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5 | ||||||||
| Address2: | |||||||||
| City: | WINOOSKI | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054040005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028570400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8515 E ORCHARD RD | ||||||||
| Address2: | C/O GREAT WEST EMPLOYEE HEALTH CENTER | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801115002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037375500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2015 | ||||||||
| LastUpdateDate: | 10/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | CARLSON | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8028570400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MH HEALTH CARE SERVICES, PC | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.