1215151410 NPI number — STATE OF VERMONT

Table of content: (NPI 1215151410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215151410 NPI number — STATE OF VERMONT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE OF VERMONT
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 DEPARTMENT OF HEALTH LABORATORY
Provider Other Organization Name Type Code:
3
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:
1215151410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70, SUITE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05402-0070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-863-7284
Provider Business Mailing Address Fax Number:
802-863-7632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VERMONT PUBLIC HEALTH LABORATORY
Provider Second Line Business Practice Location Address:
359 SOUTH PARK DRIVE
Provider Business Practice Location Address City Name:
COLCHESTER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-863-7284
Provider Business Practice Location Address Fax Number:
802-863-7632
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DALEY
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCIAL DIRECTOR
Authorized Official Telephone Number:
802-863-7284

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0008013 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com