| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 152 Colby St, Colebrook, New Hampshire |
| Authorized Official Name and Position | Nicholas Vailas (CEO) |
| Authorized Official Contact | 6037315589 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
700 Lake Ave Ste 2 Manchester NH 03103-2734 Ph: (603) 621-0681 | 152 Colby St Colebrook NH 03576 Ph: (603) 731-5589 |
| NPI Number | 1083133870 |
|---|---|
| Provider Enumeration Date | 09/13/2017 |
| Last Update Date | 11/25/2019 |
| Medicare PECOS PAC ID | 1951661164 |
|---|---|
| Medicare Enrollment ID | O20210413002328 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083133870 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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