Provider Demographics
NPI:1295832400
Name:WINDSOR HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:WINDSOR HOSPITAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-457-5405
Mailing Address - Street 1:32 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VT
Mailing Address - Zip Code:05091-1122
Mailing Address - Country:US
Mailing Address - Phone:802-457-3030
Mailing Address - Fax:802-457-2157
Practice Address - Street 1:32 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VT
Practice Address - Zip Code:05091-1122
Practice Address - Country:US
Practice Address - Phone:802-457-3030
Practice Address - Fax:802-457-2157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINDSOR HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT703207Q00000X, 207R00000X, 207V00000X, 207W00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN0993Medicaid
VT0VN0993Medicaid