Provider Demographics
NPI:1275126260
Name:NORTHEASTERN VERMONT REGIONAL HOSPITAL, INC
Entity Type:Organization
Organization Name:NORTHEASTERN VERMONT REGIONAL HOSPITAL, INC
Other - Org Name:NVRH PULMONOLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:HERSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-748-7520
Mailing Address - Street 1:PO BOX 905
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-0905
Mailing Address - Country:US
Mailing Address - Phone:802-748-8141
Mailing Address - Fax:802-748-4098
Practice Address - Street 1:1290 HOSPITAL DR, LOWER LEVEL
Practice Address - Street 2:
Practice Address - City:ST. JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819
Practice Address - Country:US
Practice Address - Phone:802-745-6800
Practice Address - Fax:802-748-4098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6706597Medicaid
NH3127312Medicaid