Provider Demographics
NPI:1245244144
Name:RUTLAND REGIONAL HEALTH SERVICES
Entity Type:Organization
Organization Name:RUTLAND REGIONAL HEALTH SERVICES
Other - Org Name:RUTLAND CARDIOVASCULAR ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:OGORZOLEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-747-1630
Mailing Address - Street 1:1 COMMONS ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4652
Mailing Address - Country:US
Mailing Address - Phone:802-775-2937
Mailing Address - Fax:
Practice Address - Street 1:1 COMMONS ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4652
Practice Address - Country:US
Practice Address - Phone:802-775-2937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1917Medicaid
VTOVN1917Medicaid