Healthcare Provider Details

I. General information

NPI: 1114044344
Provider Name (Legal Business Name): NORTHERN COUNTIES HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 NORTH MAIN STREET
HARDWICK VT
05843
US

IV. Provider business mailing address

165 SHERMAN DRIVE
ST. JOHNSBURY VT
05819
US

V. Phone/Fax

Practice location:
  • Phone: 802-472-2260
  • Fax: 802-472-2263
Mailing address:
  • Phone: 802-748-9405
  • Fax: 802-748-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: PATRICK FLOOD
Title or Position: EXECUTIVE DIRECTOR/CEO
Credential:
Phone: 802-748-9405