Provider Demographics
NPI:1033285796
Name:PORTER HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:PORTER HEALTH SYSTEMS, INC.
Other - Org Name:VERMONT MAIL ORDER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHS PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUONINCONTRO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:802-388-1683
Mailing Address - Street 1:111 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1102
Mailing Address - Country:US
Mailing Address - Phone:802-388-1684
Mailing Address - Fax:802-388-1688
Practice Address - Street 1:111 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1102
Practice Address - Country:US
Practice Address - Phone:802-388-1684
Practice Address - Fax:802-388-1688
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PORTER MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-27
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
VT03800032813336C0004X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4703395OtherOTHER ID NUMBER-COMMERCIAL NUMBER
4703395OtherNCPDP