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NPI Code Detail

MEDICARE: NORTH COUNTRY HEALTHCARE, INC.

MEDICARE: NORTH COUNTRY HEALTHCARE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)
2261QM1300XMulti-Specialty Clinic/CenterAZ

General Provider Information

NPI Number : 1821228826
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH COUNTRY HEALTHCARE, INC.
Provider Business Mailing Address
First Line : PO BOX 3630
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86003-3630
Country : US
Telephone Number : 928-522-9400
Fax Number :
Provider Business Practice Location Address
First Line : 2187 N VICKEY ST STE 2
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-6121
Country : US
Telephone Number : 928-527-1899
Fax Number : 928-526-9543
Authorized Official
Title or Position : CEO
Name : ANNE NEWLAND
Credential : MD
Telephone Number : 928-522-9400
Provider Enumeration Date : 07/24/2009
Last Update Date : 06/30/2021

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Directions to “NORTH COUNTRY HEALTHCARE, INC. ” Practice Location

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