Provider Demographics
NPI:1699876482
Name:NORTH COUNTRY HEALTH CARE, MEDICAL PLLC
Entity type:Organization
Organization Name:NORTH COUNTRY HEALTH CARE, MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VLADIMR
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDVED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:518-481-6044
Mailing Address - Street 1:24 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1350
Mailing Address - Country:US
Mailing Address - Phone:518-481-6044
Mailing Address - Fax:518-481-6043
Practice Address - Street 1:24 4TH ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1350
Practice Address - Country:US
Practice Address - Phone:518-481-6044
Practice Address - Fax:518-481-6043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1694Medicare PIN