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Organization
NORTHERN COUNTIES HLTH CARE INC
Active
Organization
NORTHERN COUNTIES HLTH CARE INC
Active
Other names
ISLAND POND HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL COSTA (CEO)
(802) 748-9405
Entity
Organization
Contact information
Practice address
82 MAPLE STREET, ISLAND POND, VT 05846-0425
(802) 723-4300
(802) 723-4544
Mailing address
PO BOX 425, ISLAND POND, VT 05846-0425
(802) 723-4300
(802) 723-4544
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
NULL
333600000X
Pharmacy
—
NULL
3336C0002X
Clinic Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0007175
—
VT
01
—
2101605
PK
—
Enumeration date
05/29/2007
Last updated
09/16/2019
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