NPIMap

Mid-State Health Center

Organization Active NPI Federally Qualified Health Center (FQHC) · Lincoln, NH

NPI 1194464982 · NPPES record last updated Jun 1, 2022

Key facts

NPI
1194464982
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
MID-STATE HEALTH CENTER
Practice address
6 South Mountain Drive
Lincoln, NH 03251
Phone
(603) 536-4000
NPI assigned
Jun 1, 2022
Organization subpart
No

Authorized official

Name
William Albert Sweeney
Title
Cfo
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 33

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

View all 33

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NH

Federally qualified health center certification: CCN 301858

Legal name
MID-STATE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 15, 2022
Last certification
Aug 15, 2022
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Enrollment address
6 S Mountain Rd
Lincoln, NH 32514268

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Louis Bickford
Individual 		Corporate Director
Board of Directors		 Dec 19, 2017
Nicholas Coates
Individual 		Corporate Director
Director		 May 21, 2018
Isaac Davis
Individual 		Corporate Director
Director		 Feb 26, 2019
Michael Long
Individual 		Corporate Director
Director		 May 28, 2019
Peter Laufenberg
Individual 		Corporate Director
Director		 Dec 27, 2016
Robert J Macleod
Individual 		Corporate Officer
Ceo		 Jun 18, 2018
W-2 Managing Employee
Ceo		 Jun 18, 2018
Joseph Monti
Individual 		Corporate Director
Director		 Jul 23, 2019
Carina Park
Individual 		Corporate Director
Director		 Apr 24, 2019
William a Sweeney
Individual 		Corporate Officer
Cfo		 Jan 1, 1998

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
O20220823003722 NH Part a Provider - Federally Qualified Health Center (FQHC) 1951363563 Practice locations: Lincoln, NH

National Provider Directory

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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

6 South Mountain Drive
Lincoln, NH 03251

Mailing address

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

Other providers in Lincoln, NH

All providers in Lincoln, NH · Federally Qualified Health Center (FQHC) in New Hampshire

Sources for this page

Verify at the official NPI Registry.