Provider Demographics
NPI:1235116310
Name:CHAMPLAIN OBSTETRICS AND GYNECOLOGY, P.C.
Entity Type:Organization
Organization Name:CHAMPLAIN OBSTETRICS AND GYNECOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-879-1802
Mailing Address - Street 1:55 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3191
Mailing Address - Country:US
Mailing Address - Phone:802-879-1802
Mailing Address - Fax:802-878-6131
Practice Address - Street 1:55 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3191
Practice Address - Country:US
Practice Address - Phone:802-879-1802
Practice Address - Fax:802-878-6131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0005293OtherBCBS
VT0005293Medicaid
VT=========OtherEIN
VT0005293Medicaid