1881686533 NPI number — MARK A HEALEY MD PC

Table of content: (NPI 1881686533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881686533 NPI number — MARK A HEALEY MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK A HEALEY MD PC
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:
MOUNTAINVIEW SURGERY
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:
1881686533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
308 BLAKELY RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
COLCHESTER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05446-3901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-658-5600
Provider Business Mailing Address Fax Number:
802-658-5605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
308 BLAKELY RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
COLCHESTER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05446-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-658-5600
Provider Business Practice Location Address Fax Number:
802-658-5605
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HEALEY
Authorized Official First Name:
MARK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
802-658-5606

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , 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: DD8475 . This is a "RR MEDICARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1009516 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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