Healthcare Provider Details

I. General information

NPI: 1750646741
Provider Name (Legal Business Name): HIGH COUNTRY COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 STATE FARM RD
BOONE NC
28607-4948
US

IV. Provider business mailing address

PO BOX 1490
BOONE NC
28607-0682
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-3886
  • Fax: 828-265-4816
Mailing address:
  • Phone: 828-262-3886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALICE SALTHOUSE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MHA
Phone: 828-262-3886