1104868892 NPI number — NORTH COUNTRY HOSPITAL & HEALTH CENTER INC

Table of content: (NPI 1104868892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104868892 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:
Provider Other Organization Name Type Code:
6
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:
1104868892
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:
189 PROUTY 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:
05855-9326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-334-7331
Provider Business Mailing Address Fax Number:
802-334-3281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
488 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05822-8637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-525-3539
Provider Business Practice Location Address Fax Number:
802-525-3088
Provider Enumeration Date:
06/10/2006

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: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0473987 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: NORT00029083 . This is a "BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0VN1505 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: CA2318 . This is a "MEDICARE RR" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 101315300 . This is a "WC - US DEPT OF LABOR" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 8000697 . This is a "LADIES FIRST" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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