1326594359 NPI number — VERMONT HOLISTIC HEALTH PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326594359 NPI number — VERMONT HOLISTIC HEALTH PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERMONT HOLISTIC HEALTH PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VERMONT HOUSECALLS LLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326594359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
704 STAPLES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANBY
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05739-9341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-293-2929
Provider Business Mailing Address Fax Number:
802-419-8311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5053 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER CENTER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05255-9771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-293-2929
Provider Business Practice Location Address Fax Number:
802-419-8311
Provider Enumeration Date:
08/30/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GOODWIN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
802-293-2929

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  101.0107976 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Y400311948 . This is a "MEDICARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: Y400291819 . This is a "MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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