Provider Demographics
NPI:1093146755
Name:NORTH COUNTRY HEALTHCARE INC
Entity Type:Organization
Organization Name:NORTH COUNTRY HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-522-9400
Mailing Address - Street 1:PO BOX 3630
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-3630
Mailing Address - Country:US
Mailing Address - Phone:928-522-9400
Mailing Address - Fax:
Practice Address - Street 1:126 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5488
Practice Address - Country:US
Practice Address - Phone:928-472-3700
Practice Address - Fax:928-468-8605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH COUNTRY HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-06
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207Q00000X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ70394Medicare Oscar/Certification
AZ031913Medicare Oscar/Certification