Provider Demographics
NPI:1164605283
Name:SICKCARE PLLC
Entity Type:Organization
Organization Name:SICKCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-253-2726
Mailing Address - Street 1:394 MOUNTAIN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-4678
Mailing Address - Country:US
Mailing Address - Phone:802-253-2726
Mailing Address - Fax:802-253-8021
Practice Address - Street 1:394 MOUNTAIN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-4678
Practice Address - Country:US
Practice Address - Phone:802-253-2726
Practice Address - Fax:802-253-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420009406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VN3636Medicare PIN