Organization
NORTHERN COUNTIES HEALTH CARE, INC.
Active
Other names
Island Pond Health & Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK FLOOD (EXECUTIVE DIRECTOR/CEO)
(802) 748-9405
Entity
Organization
Contact information
Practice address
82 MAPLE STREET, ISLAND POND, VT 05846
(802) 723-4300
(802) 723-4544
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
—
0473811
—
VT
01
—
471804
MEDICARE PROVIDER NUMBER
VT
Enumeration date
03/26/2007
Last updated
01/30/2014
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