1528168762 NPI number — VA MEDICAL CENTER 215 NORTH MAIN STREET WRJ VT 05009

Table of content: (NPI 1528168762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528168762 NPI number — VA MEDICAL CENTER 215 NORTH MAIN STREET WRJ VT 05009

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VA MEDICAL CENTER 215 NORTH MAIN STREET WRJ VT 05009
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:
Provider Other Last Name:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1528168762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 ORCHARD HILL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANOVER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03755-4702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-643-8441
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VA MEDICAL CTR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE RIVER JUNCTION
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05009-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-295-9363
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURCHARD
Authorized Official First Name:
MARION
Authorized Official Middle Name:
Authorized Official Title or Position:
ADULT NURSE PRACTITIONER
Authorized Official Telephone Number:
18022959363

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  0342382305 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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