Provider Demographics
NPI:1568414365
Name:COPLEY HOSPITAL, INC.
Entity Type:Organization
Organization Name:COPLEY HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-888-8663
Mailing Address - Street 1:528 WASHINGTON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8973
Mailing Address - Country:US
Mailing Address - Phone:802-888-8888
Mailing Address - Fax:802-888-8203
Practice Address - Street 1:528 WASHINGTON HIGHWAY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8973
Practice Address - Country:US
Practice Address - Phone:802-888-4231
Practice Address - Fax:802-888-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT275N00000X
VT667282NC0060X
VT731282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0005776Medicaid
VT0471305Medicaid
VT047Z305Medicaid
VT0005574Medicaid
VT1012122Medicaid
VT8000452Medicaid
VT1012296Medicaid
VT0005696Medicaid
VT1012296Medicaid
VTVT5696Medicare Oscar/Certification
VT047Z305Medicaid
VT0471305Medicaid
VTVT5574Medicare Oscar/Certification
VTVN3903Medicare Oscar/Certification
VT471305Medicare Oscar/Certification