Provider Demographics
NPI:1437280344
Name:NORTH COUNTRY HOSPITAL & HEALTH CENTER INC
Entity Type:Organization
Organization Name:NORTH COUNTRY HOSPITAL & HEALTH CENTER INC
Other - Org Name:NORTH COUNTRY DERMATOLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-334-4111
Mailing Address - Street 1:189 PROUTY DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9326
Mailing Address - Country:US
Mailing Address - Phone:802-334-4111
Mailing Address - Fax:802-334-3281
Practice Address - Street 1:189 PROUTY DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9326
Practice Address - Country:US
Practice Address - Phone:802-334-4111
Practice Address - Fax:802-334-3281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTCA2318OtherMEDICARE RAIL ROAD
VT1008041Medicaid
NH30201819Medicaid
VTNORT00029083OtherBLUE CROSS BLUE SHIELD
VT1008041Medicaid