Provider Demographics
NPI:1114092327
Name:TACONIC ORTHOPAEDICS PC
Entity Type:Organization
Organization Name:TACONIC ORTHOPAEDICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERICAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-366-1144
Mailing Address - Street 1:3505 RICHVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CTR
Mailing Address - State:VT
Mailing Address - Zip Code:05255
Mailing Address - Country:US
Mailing Address - Phone:023-661-1448
Mailing Address - Fax:802-768-8466
Practice Address - Street 1:3505 RICHVILLE RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-9812
Practice Address - Country:US
Practice Address - Phone:802-366-1144
Practice Address - Fax:802-768-8466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0005591Medicaid
VT00019364OtherBC/BS
VT932666OtherMVP
VT00018953OtherBC/BS
VT635529OtherMVP
VT=========OtherCDPHP
VTAP0547Medicare PIN
VT00019364OtherBC/BS
VT0005591Medicaid
VT932666OtherMVP
VT0357990001Medicare NSC
VTVT5591Medicare PIN
VT635529OtherMVP