Provider Demographics
NPI:1568501591
Name:UNIVERSITY OF VERMONT MEDICAL CENTER INC
Entity Type:Organization
Organization Name:UNIVERSITY OF VERMONT MEDICAL CENTER INC
Other - Org Name:UVM MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-847-1882
Mailing Address - Street 1:1 S PROSPECT ST
Mailing Address - Street 2:SUITE 1413
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3456
Mailing Address - Country:US
Mailing Address - Phone:802-847-5519
Mailing Address - Fax:802-847-5518
Practice Address - Street 1:1 S PROSPECT ST
Practice Address - Street 2:SUITE 1413
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3456
Practice Address - Country:US
Practice Address - Phone:802-847-5519
Practice Address - Fax:802-847-5518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT332B00000X
332BP3500X, 3336C0003X
VT038-00653863336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012210Medicaid
VT1012210Medicaid