| North Country Healthcare, Inc. | |
| 
					1 Clinic Road Grand Canyon AZ 86023  | |
| (928) 638-2551 | |
| (928) 638-2598 | 
| Full Name | North Country Healthcare, Inc. | 
|---|---|
| Speciality | Clinic/Center | 
| Location | 1 Clinic Road, Grand Canyon, Arizona | 
| Authorized Official Name and Position | Anne Newland (CEO) | 
| Authorized Official Contact | 9285229400 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| North Country Healthcare, Inc. Po Box 3630 Flagstaff AZ 86003-3630 Ph: (928) 522-9400  | North Country Healthcare, Inc. 1 Clinic Road Grand Canyon AZ 86023 Ph: (928) 638-2551  | 
| NPI Number | 1891810024 | 
|---|---|
| Provider Enumeration Date | 03/20/2007 | 
| Last Update Date | 06/30/2021 | 
| Medicare PECOS PAC ID | 8820981053 | 
|---|---|
| Medicare Enrollment ID | O20090312000491 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1891810024 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary | 
| 261QM1300X | Clinic/center - Multi-specialty | (Arizona) | Primary |