Provider Demographics
NPI:1083678833
Name:RUTLAND HOSPITAL, INC.
Entity Type:Organization
Organization Name:RUTLAND HOSPITAL, INC.
Other - Org Name:RUTLAND REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:KENNEDY
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-747-1632
Mailing Address - Street 1:160 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4560
Mailing Address - Country:US
Mailing Address - Phone:802-775-7111
Mailing Address - Fax:802-775-7214
Practice Address - Street 1:160 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4560
Practice Address - Country:US
Practice Address - Phone:802-775-7111
Practice Address - Fax:802-775-7214
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUTLAND HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-17
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT788174400000X
VT676282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT59663OtherBC SPECIALTY PROV #
VT1009146Medicaid
VTVT9678Medicare ID - Type UnspecifiedM/CARE SPECIALTY PROV #