1245366277 NPI number — VERMONT PHYSICIANS CLINIC

Table of content: (NPI 1245366277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245366277 NPI number — VERMONT PHYSICIANS CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERMONT PHYSICIANS CLINIC
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:
1245366277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
69 ALLEN ST
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
RUTLAND
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05701-4564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-786-9063
Provider Business Mailing Address Fax Number:
802-747-4532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
69 ALLEN ST
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
RUTLAND
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05701-4564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-786-9063
Provider Business Practice Location Address Fax Number:
802-747-4532
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRUPNICK
Authorized Official First Name:
KURT
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
802-786-9063

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: KRUP11138661 . This is a "KURT BC BS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: ONP1198 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 58743 . This is a "KIM EUGAIR BC BS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: KRUP05338662 . This is a "DEB BC BS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: OVN1791 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1008860 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: OVN1768 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: VERM31138660 . This is a "GROUP BC BS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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