Provider Demographics
NPI:1609896935
Name:PORTER HOSPITAL INC
Entity Type:Organization
Organization Name:PORTER HOSPITAL INC
Other - Org Name:PORTER HOSPITAL INC DBA NESHOBE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:CIAMPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-388-4752
Mailing Address - Street 1:104 PORTER DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-8527
Mailing Address - Country:US
Mailing Address - Phone:802-388-5682
Mailing Address - Fax:802-388-5692
Practice Address - Street 1:61 COURT DR
Practice Address - Street 2:NESHOBE FAMILY MEDICINE
Practice Address - City:BRANDON
Practice Address - State:VT
Practice Address - Zip Code:05733
Practice Address - Country:US
Practice Address - Phone:802-247-3755
Practice Address - Fax:802-247-4560
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PORTER HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-20
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1032Medicaid
VN1032Medicare ID - Type Unspecified