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General NPI Number Information
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NPI Number | 1992822555
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Entity Type | Organization
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Legal Business Name | NORTHERN COUNTIES HEALTH CARE, INC.
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 82 MAPLE STREET
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City | ISLAND POND
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State | VT
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Zip | 05846
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Country | US
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Telephone | 802-723-4300
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Fax | 802-723-4544
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Provider Business Mailing Address
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Address Line | 165 SHERMAN DRIVE
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City | ST JOHNSBURY
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State | VT
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Zip | 05819
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Country | US
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Telephone | 802-748-9405
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Fax | 802-748-4540
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/CEO
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Name | PATRICK FLOOD
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Credential |
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Telephone | 802-748-9405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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