Provider Demographics
NPI:1962533877
Name:NORTH COUNTRY HOSPITAL AND HEALTH CENTER INC
Entity type:Organization
Organization Name:NORTH COUNTRY HOSPITAL AND HEALTH CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
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:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTNORT00018788OtherBLUE CROSS VERMONT
VT0VN0493Medicaid
VT391760OtherMVP
VTNORT00018788OtherBLUE CROSS VERMONT
VTVN0493Medicare ID - Type UnspecifiedMEDICARE VERMONT