Provider Demographics
NPI:1336606938
Name:HIGH COUNTRY COMMUNITY HEALTH
Entity Type:Organization
Organization Name:HIGH COUNTRY COMMUNITY HEALTH
Other - Org Name:HIGH COUNTRY COMMUNITY HEALTH PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 1:110 DUTCHMAN CT
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2237
Practice Address - Country:US
Practice Address - Phone:336-835-7337
Practice Address - Fax:336-835-7301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGH COUNTRY COMMUNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-01
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1336606938Medicaid