Provider Demographics
NPI:1386689875
Name:NORTHWESTERN MEDICAL CENTER INC
Entity Type:Organization
Organization Name:NORTHWESTERN MEDICAL CENTER INC
Other - Org Name:NORTHWESTERN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PAYOR CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-524-8954
Mailing Address - Street 1:133 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1726
Mailing Address - Country:US
Mailing Address - Phone:802-524-1076
Mailing Address - Fax:802-524-8803
Practice Address - Street 1:133 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1726
Practice Address - Country:US
Practice Address - Phone:802-524-1076
Practice Address - Fax:802-524-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT282N00000X
VT03700016703336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT470024Medicaid
2101324OtherPK