Basic Information
| Provider Information | |||||||||
| NPI: | 1982016697 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH COUNTRY HEALTH CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3994 HAINES RD | ||||||||
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| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558111743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182133232 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1510 N STOCKTON HILL RD | ||||||||
| Address2: | |||||||||
| City: | KINGMAN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864015173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287531177 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2014 | ||||||||
| LastUpdateDate: | 05/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | ROGGENBUCK | ||||||||
| AuthorizedOfficialFirstName: | ANN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9282335110 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | R 196496-7 | MN | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.