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
—
—
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
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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