1417023904 NPI number — NORTH COUNTRY HOSPITAL & HEALTH CENTER INC

Table of content: (NPI 1417023904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417023904 NPI number — NORTH COUNTRY HOSPITAL & HEALTH CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH COUNTRY HOSPITAL & HEALTH CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTH COUNTRY PRIMARY CARE NEWPORT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417023904
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
186 MEDICAL VILLAGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05855-8537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-334-3522
Provider Business Mailing Address Fax Number:
802-334-3512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
186 MEDICAL VILLAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05855-8537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-334-3520
Provider Business Practice Location Address Fax Number:
802-334-3281
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ENROLLMENT SPECIALIST
Authorized Official Telephone Number:
802-334-3210

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0473979 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0VN0873 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: NORT00019718 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: CN1521 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 8000696 . This is a "LADIES FIRST" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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