Provider Demographics
NPI:1518620665
Name:HIGH COUNTRY COMMUNITY HEALTH
Entity Type:Organization
Organization Name:HIGH COUNTRY COMMUNITY HEALTH
Other - Org Name:HIGH COUNTRY COMMUNITY HEALTH PRIMEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALTHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-262-3886
Mailing Address - Street 1:PO BOX 1490
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-1490
Mailing Address - Country:US
Mailing Address - Phone:828-262-3886
Mailing Address - Fax:828-265-4816
Practice Address - Street 1:240 HIGHWAY 105 EXT STE 100
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4291
Practice Address - Country:US
Practice Address - Phone:828-264-7311
Practice Address - Fax:828-265-4816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)