1679560668 NPI number — WINDSOR HOSPITAL CORPORATION

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 1679560668 NPI number — WINDSOR HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINDSOR HOSPITAL CORPORATION
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:
MT ASCUTNEY HOSPITAL AND HEALTH CENTER
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:
1679560668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
289 COUNTY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDSOR
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05089-9000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-674-7291
Provider Business Mailing Address Fax Number:
802-674-7150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
289 COUNTY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDSOR
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05089-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-674-7022
Provider Business Practice Location Address Fax Number:
802-674-7006
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SANVILLE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
802-674-7240

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X , with the licence number:  703 , 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: 0471302 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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