| Indian Stream Health Center, Inc | |
|
141 Corliss Lane Colebrook NH 03576 | |
| (603) 237-8336 | |
| (603) 237-4467 |
| Full Name | Indian Stream Health Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 141 Corliss Lane, Colebrook, New Hampshire |
| Authorized Official Name and Position | Jonathan W. Brown (CEO) |
| Authorized Official Contact | 6033882426 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indian Stream Health Center, Inc 141 Corliss Lane Colebrook NH 03576 Ph: (603) 237-8336 | Indian Stream Health Center, Inc 141 Corliss Lane Colebrook NH 03576 Ph: (603) 237-8336 |
| NPI Number | 1386673952 |
|---|---|
| Provider Enumeration Date | 07/03/2006 |
| Last Update Date | 01/27/2015 |
| Medicare PECOS PAC ID | 4789621921 |
|---|---|
| Medicare Enrollment ID | O20051209000107 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386673952 | NPI | - | NPPES |
| 7459647 | Other | NH | AETNA |
| 8000921 | Medicaid | VT | |
| 200010975 | Other | NH | MVP |
| 30213617 | Medicaid | NH | |
| 30513983 | Medicaid | NH | |
| 8190651 | Other | NH | CIGNA |
| 00068661 | Other | VT | BCBS OF VT |
| 1011463 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (New Hampshire) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (New Hampshire) | Primary |
| Provider Name | Kermit Brion Brunelle |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477529006 PECOS PAC ID: 3476872763 Enrollment ID: I20150508000433 |
| Provider Name | Hope P Watts |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861465056 PECOS PAC ID: 6800781303 Enrollment ID: I20201104002575 |
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