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Mid-State Health Center

Organization Active NPI Clinical Medical Laboratory · Bristol, NH

NPI 1033829965 · NPPES record last updated Dec 1, 2022

Key facts

NPI
1033829965
Entity type
Organization (NPI type 2)
Primary specialty
Clinical Medical Laboratory 291U00000X
Legal business name
MID-STATE HEALTH CENTER
Practice address
100 Robie Road
Bristol, NH 03222
Phone
(603) 536-4000
Fax
(603) 536-4001
NPI assigned
Dec 1, 2022
Organization subpart
No

Authorized official

Name
Robert Macleod
Title
Ceo
Phone
(603) 536-4000

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 16

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 32

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
30D0979580Mid-State Health Center
100 Robie Rd, Bristol, NH 03222		ComplianceJun 26, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NH

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mid-State Health Center
Plymouth, NH · CCN 301817		 Federally qualified health center Operational/Managerial Control Jan 9, 1998

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20230124002553 NH Part B Supplier - Independent Clinical Laboratory 1951363563 Practice locations: Bristol, NH

National Provider Directory

Tax ID family
Sma Bristol (17 organizations share this tax ID)

Locations

101 Boulder Point Dr
Ste 1
Plymouth, NH 03264
Phone (603) 238-3537

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Yes

Addresses

Primary practice location

100 Robie Road
Bristol, NH 03222

Mailing address

101 Boulder Point Dr Ste 1
Plymouth, NH 03264-3170
Phone (603) 536-4000

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 1, 2022.

{
    "created_epoch": "1669852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669852800000",
    "number": "1033829965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BOULDER POINT DR STE 1",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "032643170",
            "telephone_number": "603-536-4000",
            "fax_number": "603-536-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 ROBIE ROAD",
            "city": "BRISTOL",
            "state": "NH",
            "postal_code": "03222",
            "telephone_number": "603-536-4000",
            "fax_number": "603-536-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-STATE HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-01",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "status": "A",
        "authorized_official_last_name": "MACLEOD",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "603-536-4000"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, NH

All providers in Bristol, NH · Clinical Medical Laboratory in New Hampshire

Sources for this page

Verify at the official NPI Registry.