NORTH COUNTRY HEALTHCARE, INC. NPI 1942324686

Clinic/Center (Multi-Specialty) in Ashfork, AZ

NPI 1942324686 Organization Clinic/Center Multi-Specialty CLIA Number 03D0903892 CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP)

About NORTH COUNTRY HEALTHCARE, INC.

North Country Healthcare, Inc. is a provider established in Ashfork, Arizona specializing in clinic/center (multi-specialty) . The NPI number of North Country Healthcare, Inc. is 1942324686 and was assigned on March 2007. The practitioner's primary taxonomy code is 261QM1300X. The provider is registered as an organization and their NPI record was last updated 6 years ago. The authorized official of this NPI record is Anne Newland M.d. (Ceo/cmo)

The CLIA number of North Country Healthcare, Inc. is 03D0903892 registered as a "federally qualified health center" facility with a CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP). This CLIA certificate is issued to North Country Healthcare, Inc. in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.

NPI

1942324686

Provider NameNORTH COUNTRY HEALTHCARE, INC.
Provider Location Address112 PARK AVENUE ASHFORK, AZ 86320
Provider Mailing AddressPO BOX 3630 FLAGSTAFF, AZ 86003
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?Yes
Enumeration Date03-19-2007
Last Update Date07-26-2016


Primary Taxonomy

Taxonomy Code261QM1300X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationMulti-Specialty
License StateAZ

Business Address

NORTH COUNTRY HEALTHCARE, INC.
112 PARK AVENUE
ASHFORK, AZ
ZIP 86320
Phone: (928) 637-2305
Fax: (928) 637-2343

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Mailing Address

NORTH COUNTRY HEALTHCARE, INC.
PO BOX 3630
FLAGSTAFF, AZ
ZIP 86003
Phone: (928) 522-9879
Fax: (928) 522-9880



Authorized Official

Authorized Official Name ANNE NEWLAND M.D.
Authorized Official TitleCEO/CMO
Authorized Official Phone(928) 522-9576

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1942324686 is:

CLIA Number03D0903892
Facility TypeFEDERALLY QUALIFIED HEALTH CENTER
Certificate TypeCertificate for Provider-Performed Microscopy Procedures (PPMP)

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
Z20283MEDICARE PIN (08)AZ
031829MEDICARE OSCAR/CERTIFICATION (06)AZ

Other Providers at the same location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1780637066DR. W SHELBY RUTLEDGE M.D.
Individual
Family Medicine112 PARK AVENUE
ASH FORK, AZ 86320
(928) 637-2305

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.