Provider Demographics
NPI:1265505820
Name:LACTATION RESOURCES OF VT INC
Entity Type:Organization
Organization Name:LACTATION RESOURCES OF VT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:V
Authorized Official - Last Name:BIBB
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:802-878-6181
Mailing Address - Street 1:54 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465
Mailing Address - Country:US
Mailing Address - Phone:802-878-6181
Mailing Address - Fax:
Practice Address - Street 1:54 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:VT
Practice Address - Zip Code:05465
Practice Address - Country:US
Practice Address - Phone:802-878-6181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1004341Medicaid
VTLACT29985OtherBCBS OF VT