Provider Demographics
NPI:1336492073
Name:VERMONT MEDICAL SLEEP DISORDERS CENTER, INC.
Entity Type:Organization
Organization Name:VERMONT MEDICAL SLEEP DISORDERS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:PAQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT, RST
Authorized Official - Phone:802-878-4445
Mailing Address - Street 1:139 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3659
Mailing Address - Country:US
Mailing Address - Phone:802-878-4445
Mailing Address - Fax:802-878-4607
Practice Address - Street 1:6 HOME HEALTH CIRCLE
Practice Address - Street 2:SUITE2
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478
Practice Address - Country:US
Practice Address - Phone:802-524-9809
Practice Address - Fax:802-524-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0007177Medicaid
VT0542730004Medicare NSC