| Vailas Medical Clinic | |
|
152 Colby St Colebrook NH 03576 | |
| (603) 731-5589 | |
| Not Available |
| Full Name | Vailas Medical Clinic |
|---|---|
| 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 |
|---|---|
| Vailas Medical Clinic 700 Lake Ave Ste 2 Manchester NH 03103-2734 Ph: (603) 621-0681 | Vailas Medical Clinic 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 | O20180529000949 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083133870 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | John J Fothergill |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336198175 PECOS PAC ID: 9436144607 Enrollment ID: I20040723000825 |
| Provider Name | Denise Poudrier Normandin |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1104091578 PECOS PAC ID: 0446599534 Enrollment ID: I20190307002141 |
| Provider Name | Keri Mellett Stiles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477115053 PECOS PAC ID: 7810223336 Enrollment ID: I20190722002265 |
| Provider Name | Shannon Murphy-miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740807114 PECOS PAC ID: 5890180434 Enrollment ID: I20220318000215 |
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