# NORTHERN COUNTIES HLTH CARE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ISLAND POND HEALTH CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730101312
- **Authorized official:** JACK DONNELLY (DIR OF OPERATIONS)
- **Authorized official phone:** (802) 748-9405

## Contact information

- **Practice address:** 82 MAPLE STREET, ISLAND POND, VT 05846-0425
- **Practice address phone:** (802) 723-4300
- **Practice address fax:** (802) 723-4544
- **Mailing address:** PO BOX 425, ISLAND POND, VT 05846-0425

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0002X | Clinic Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 07/24/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0007175 | — | VT |
| 01 | — | 4703270 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |