Basic Information
| Provider Information | |||||||||
| NPI: | 1689799827 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH COUNTRY HEALTHCARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3630 | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860033630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285229879 | ||||||||
| FaxNumber: | 9285229880 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 NORTH 13TH WEST | ||||||||
| Address2: | |||||||||
| City: | ST. JOHNS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283373705 | ||||||||
| FaxNumber: | 9283373780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 07/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | NEWLAND | ||||||||
| AuthorizedOfficialFirstName: | ANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/CMO | ||||||||
| AuthorizedOfficialTelephone: | 9285229576 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTH COUNTRY HEALTHCARE, INC. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.