Provider Demographics
NPI:1467416206
Name:RUTLAND HOSPITAL, INC.
Entity Type:Organization
Organization Name:RUTLAND HOSPITAL, INC.
Other - Org Name:RRMC PSYCHIATRY DEPT.
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:K
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-747-1630
Mailing Address - Street 1:160 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4560
Mailing Address - Country:US
Mailing Address - Phone:802-775-7111
Mailing Address - Fax:802-775-7214
Practice Address - Street 1:160 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4560
Practice Address - Country:US
Practice Address - Phone:802-775-7111
Practice Address - Fax:802-775-7214
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUTLAND HOSPITAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-17
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT692103TC0700X, 1041C0700X
VT788261QM2800X
VT676273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes273R00000XHospital UnitsPsychiatric Unit
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT276-4910OtherBC PSYCH PROV #
VT0004910Medicaid
VTVT4910Medicare PIN
VTRUVN0331Medicare PIN
VT0004910Medicaid
VTRUVN0840Medicare ID - Type UnspecifiedRRMC LICSW