Provider Demographics
NPI:1508373572
Name:FAMILY MEDICINE PARTNERS - VERMONT
Entity Type:Organization
Organization Name:FAMILY MEDICINE PARTNERS - VERMONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSELIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-872-4326
Mailing Address - Street 1:66 KNIGHT LN STE 10
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-9308
Mailing Address - Country:US
Mailing Address - Phone:802-872-4343
Mailing Address - Fax:802-872-0907
Practice Address - Street 1:66 KNIGHT LN STE 10
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-9308
Practice Address - Country:US
Practice Address - Phone:802-872-4343
Practice Address - Fax:802-872-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty