1043211618 NPI number — CITY OF SO BURLINGTON

Table of content: (NPI 1043211618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043211618 NPI number — CITY OF SO BURLINGTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF SO BURLINGTON
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:
1043211618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 DORSET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BURLINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05403-6260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-846-4110
Provider Business Mailing Address Fax Number:
802-846-4125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 DORSET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05403-6260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-846-4110
Provider Business Practice Location Address Fax Number:
802-846-4125
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BRENT
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CHIEF OF FIRE & EMS
Authorized Official Telephone Number:
802-863-4110

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  0338 , 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: 02623141 . This is a "MEDICAID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1720546 . This is a "MEDICAID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0AM0186 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0AM0186 . This is a "MAIL HANDLER'S BENEFIT PL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 373021 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 68195 . This is a "BCBS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 30823338 . This is a "MEDICAID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: P00152414 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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