1770933897 NPI number — UNIVERSITY OF VERMONT MEDICAL CENTER INC

Table of content: (NPI 1770933897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770933897 NPI number — UNIVERSITY OF VERMONT MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF VERMONT MEDICAL CENTER INC
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:
UNIVERSITY OF VERMONT MEDICAL CENTER HOME DIALYSIS
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:
1770933897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 COLCHESTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05401-1473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-847-0000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 JOY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
S BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05403-6119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-847-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
VINCENT
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
802-847-2089

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  844 , 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)





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