Provider Demographics
NPI:1639873839
Name:RIVER'S EDGE INTEGRATIVE MEDICINE PLLC
Entity Type:Organization
Organization Name:RIVER'S EDGE INTEGRATIVE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-744-7284
Mailing Address - Street 1:4372 VERMONT ROUTE 100
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:VT
Mailing Address - Zip Code:05674-9728
Mailing Address - Country:US
Mailing Address - Phone:603-783-6714
Mailing Address - Fax:949-437-3084
Practice Address - Street 1:4374 RT 100
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:VT
Practice Address - Zip Code:05674-0567
Practice Address - Country:US
Practice Address - Phone:802-744-7284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care