North Country Medical and Wellness, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

NORTH COUNTRY MEDICAL AND WELLNESS, LLC

Doing business as

Vailas Medical Clinic

Practice address

152 Colby St
Colebrook, NH 03576

Phone

(603) 731-5589

NPI assigned

Sep 13, 2017

Last updated

Nov 25, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicholas Vailas

Title

Ceo

Phone

(603) 731-5589

Specialties & licenses 1

Addresses

Other names 1

• Vailas Medical Clinic Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574640000000",
    "number": "1083133870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 LAKE AVE STE 2",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031032734",
            "telephone_number": "603-621-0681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 COLBY ST",
            "city": "COLEBROOK",
            "state": "NH",
            "postal_code": "03576",
            "telephone_number": "603-731-5589"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "35 Kosciuszko St",
            "address_purpose": "LOCATION",
            "city": "Manchester",
            "state": "NH",
            "postal_code": "031011608",
            "country_code": "US",
            "telephone_number": "603-627-8053",
            "fax_number": "603-627-4241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTH COUNTRY MEDICAL AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-13",
        "last_updated": "2019-11-25",
        "status": "A",
        "authorized_official_last_name": "VAILAS",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "603-731-5589"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vailas Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Crystal Lee Ouimette, BS
• Sheila J. Parkhurst, PHD., LMP
• Eleanor Elizabeth Pearson, RN CDE
• Carrie L Rancourt, RD, LD, CDE

• Primary Care Clinic/Center in Colebrook, NH
• Providers in Colebrook, NH by specialty
• Primary Care Clinic/Center in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.