Healthcare Provider Details

I. General information

NPI: 1790809879
Provider Name (Legal Business Name): NORTH COUNTRY HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 S. MOUNTAIN AVE.
SPRINGERVILLE AZ
85938
US

IV. Provider business mailing address

PO BOX 3630
FLAGSTAFF AZ
86003-3630
US

V. Phone/Fax

Practice location:
  • Phone: 928-333-0127
  • Fax: 928-333-4799
Mailing address:
  • Phone: 928-522-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name: ANNE M. NEWLAND
Title or Position: CEO
Credential: MD
Phone: 928-522-9400