Provider Demographics
NPI:1518613215
Name:COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION INC
Other - Org Name:COMMUNITY HEALTH NORTH MAIN ST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-468-9118
Mailing Address - Street 1:71 ALLEN ST STE 402
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4570
Mailing Address - Country:US
Mailing Address - Phone:800-468-9118
Mailing Address - Fax:
Practice Address - Street 1:231 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-2412
Practice Address - Country:US
Practice Address - Phone:800-468-9118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-22
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty