Organization
NORTHERN COUNTIES HEALTH CARE, INC.
Active
Other names
Concord Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL COSTA (EXECUTIVE DIRECTOR/CEO)
(802) 748-9405
Entity
Organization
Contact information
Practice address
185 SHERMAN DR, ST JOHNSBURY, VT 05819-9811
(802) 695-2512
(802) 695-1303
Mailing address
165 SHERMAN DRIVE, ST JOHNSBURY, VT 05819
(802) 748-9405
(802) 748-4540
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0473807
—
VT
01
—
471801
MEDICARE PROVIDER NUMBER
VT
Enumeration date
03/23/2007
Last updated
06/11/2021
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