1508082116 NPI number — TMS VT, LLC

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 1508082116 NPI number — TMS VT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TMS VT, LLC
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:
THE MEDICAL STORE
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:
1508082116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1284 US ROUTE 302 STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARRE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05641-2317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-476-3135
Provider Business Mailing Address Fax Number:
802-862-6482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 US ROUTE 302
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
BARRE
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05641-2379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-476-3135
Provider Business Practice Location Address Fax Number:
802-862-6482
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
802-864-0908

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1013543 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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