Provider Demographics
NPI:1386663474
Name:CENTRAL VERMONT ANESTHESIA ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CENTRAL VERMONT ANESTHESIA ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:N
Authorized Official - Last Name:GROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-496-6161
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:WAITSFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05673-0297
Mailing Address - Country:US
Mailing Address - Phone:802-496-6161
Mailing Address - Fax:802-496-6170
Practice Address - Street 1:130 FISHER RD
Practice Address - Street 2:CENTRAL VERMONT MEDICAL CENTER
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-371-4257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0004475Medicaid
VTCENT00004475OtherBLUE CROSS
VTVT4475Medicare ID - Type Unspecified