Provider Demographics
NPI:1558358747
Name:WINDSOR HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:WINDSOR HOSPITAL CORPORATION
Other - Org Name:MT ASCUTNEY HOSPITAL EMERG ROOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SANVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-674-7240
Mailing Address - Street 1:289 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:VT
Mailing Address - Zip Code:05089-9000
Mailing Address - Country:US
Mailing Address - Phone:802-674-7220
Mailing Address - Fax:802-674-7006
Practice Address - Street 1:289 COUNTY RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:VT
Practice Address - Zip Code:05089-9000
Practice Address - Country:US
Practice Address - Phone:802-674-7220
Practice Address - Fax:802-674-7006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINDSOR HOISPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-03
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT703207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0005703Medicaid
VT0005703Medicaid