1508890492 NPI number — COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION

Table of content: (NPI 1508890492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508890492 NPI number — COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION
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:
Provider Other Organization Name Type Code:
6
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:
1508890492
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71 ALLEN ST
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
RUTLAND
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05701-4570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-468-9118
Provider Business Mailing Address Fax Number:
802-772-7973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 ALLEN ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
RUTLAND
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05701-4570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-855-2083
Provider Business Practice Location Address Fax Number:
802-855-2055
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITMER
Authorized Official First Name:
GRANT
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXEC DIRECTOR
Authorized Official Telephone Number:
802-855-2083

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , 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: 0471815 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03044048 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03044057 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0471814 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0471816 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1010852 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02940256 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03891783 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1010850 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1021223 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0471842 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1010851 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1017651 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0471844 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1019786 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1025859 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03891774 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03891792 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0471836 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013682 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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