1508082116 NPI number — TMS VT, LLC

Table of content: (NPI 1508082116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508082116 NPI number — TMS VT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TMS VT, LLC
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:
1508082116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1284 US ROUTE 302 STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARRE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05641-2317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-476-3135
Provider Business Mailing Address Fax Number:
802-862-6482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 US ROUTE 302
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
BARRE
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05641-2379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-476-3135
Provider Business Practice Location Address Fax Number:
802-862-6482
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
802-864-0908

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1013543 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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