Organization Name: | INDIAN STREAM HEALTH CENTER, INC |
NPI Number: | 1215367891 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JONATHAN BROWN (CEO) |
Mailing Address: | 253 Gale St Canaan Site Canaan |
State: | VT US |
Postal Code: | 05903 |
Phone Number: | 6032378336 |
Fax Number: | 6032374467 |
NPI Enumeration Date: | 11/19/2013 |
NPI Last Update Date: | 03/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |