1891871562 NPI number — THRIVE CENTER OF THE GREEN MOUNTAINS INC

Table of content: (NPI 1891871562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891871562 NPI number — THRIVE CENTER OF THE GREEN MOUNTAINS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THRIVE CENTER OF THE GREEN MOUNTAINS 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:
Provider Other Organization Name Type Code:
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:
1891871562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P0 BOX 539
Provider Second Line Business Mailing Address:
68 SOUTH MAIN ST THRIVE CENTER OF THE GREEN MOUNTAINS
Provider Business Mailing Address City Name:
WALLINGFORD
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05773-0539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-446-2499
Provider Business Mailing Address Fax Number:
802-446-2508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
68 SOUTH MAIN ST
Provider Second Line Business Practice Location Address:
THRIVE CENTER OF THE GREEN MOUNTAINS
Provider Business Practice Location Address City Name:
WALLINGFORD
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05773-0539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-446-2499
Provider Business Practice Location Address Fax Number:
802-446-2508
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DONOHUE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PRESIDENT CHIROPRACTOR
Authorized Official Telephone Number:
802-446-2499

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0060001077 , 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: 49968 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 556340 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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