Provider Demographics
NPI: | 1023028784 |
---|---|
Name: | CENTRAL VERMONT MEDICAL CENTER INC |
Entity Type: | Organization |
Organization Name: | CENTRAL VERMONT MEDICAL CENTER INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CHEYENNE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HOLLAND |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 802-371-4109 |
Mailing Address - Street 1: | PO BOX 547 |
Mailing Address - Street 2: | |
Mailing Address - City: | BARRE |
Mailing Address - State: | VT |
Mailing Address - Zip Code: | 05641-0547 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 802-371-4100 |
Mailing Address - Fax: | 802-371-4488 |
Practice Address - Street 1: | 130 FISHER RD |
Practice Address - Street 2: | |
Practice Address - City: | BERLIN |
Practice Address - State: | VT |
Practice Address - Zip Code: | 05602-9516 |
Practice Address - Country: | US |
Practice Address - Phone: | 802-371-4100 |
Practice Address - Fax: | 802-371-4488 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | CVMC MEDICAL GROUP PRACTICES |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-08-08 |
Last Update Date: | 2024-02-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
207Q00000X, 207R00000X, 207RR0500X, 207V00000X, 207X00000X, 208000000X, 2084P0800X, 2084P0804X, 208600000X, 208800000X, 213E00000X | ||
VT | 762 | 207RC0000X, 207RE0101X |
VT | 2084N0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VT | OVN3891 | Medicaid | |
VT | OVN3891 | Medicaid |