Provider Demographics
NPI:1578527578
Name:RUTLAND HOSPITAL, INC.
Entity Type:Organization
Organization Name:RUTLAND HOSPITAL, INC.
Other - Org Name:RRMC CARDIOLOGY AND HOSPITALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:OGORZALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-747-1630
Mailing Address - Street 1:160 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4560
Mailing Address - Country:US
Mailing Address - Phone:802-775-7111
Mailing Address - Fax:802-775-7214
Practice Address - Street 1:160 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4560
Practice Address - Country:US
Practice Address - Phone:802-775-7111
Practice Address - Fax:802-775-7214
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE RUTLAND HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-14
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT788174400000X
VT676282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT5834OtherBC CARDIOLOGY PROV #
VT0005834Medicaid
VTVT5834Medicare ID - Type UnspecifiedM/CARE CARDIOLOGY PROV #