1437435245 NPI number — PORTER HOSPITAL INC

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 1437435245 NPI number — PORTER HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PORTER HOSPITAL INC
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:
CHAMPLAIN VALLEY ORTHOPEDICS
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:
1437435245
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 PORTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLEBURY
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05753-8527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-388-8808
Provider Business Mailing Address Fax Number:
802-388-8322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1436 EXCHANGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBURY
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05753-4497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-388-3194
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CIAMPA
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
802-388-4752

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , 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: 1019948 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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