Provider Demographics
NPI:1407939721
Name:FAMILY PRACTICE ASSOCIATES INC
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-644-5114
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:272 NO MAIN ST SUITE 101
Mailing Address - City:CAMBRIDGE
Mailing Address - State:VT
Mailing Address - Zip Code:05444-0102
Mailing Address - Country:US
Mailing Address - Phone:802-644-5114
Mailing Address - Fax:802-644-5573
Practice Address - Street 1:272 NO MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CAMBRIDGE
Practice Address - State:VT
Practice Address - Zip Code:05444
Practice Address - Country:US
Practice Address - Phone:802-644-5114
Practice Address - Fax:802-644-5573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0005083Medicaid
VTVT5083Medicare ID - Type Unspecified