Provider Demographics
NPI:1669677043
Name:NORTHWESTERN MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:NORTHWESTERN MEDICAL CENTER, INC.
Other - Org Name:NORTHWESTERN ORTHOPAEDICS AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-524-8954
Mailing Address - Street 1:133 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1726
Mailing Address - Country:US
Mailing Address - Phone:802-524-5911
Mailing Address - Fax:802-527-1057
Practice Address - Street 1:133 FAIRFIELD ST STE 101
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1726
Practice Address - Country:US
Practice Address - Phone:802-524-1232
Practice Address - Fax:802-524-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1014349Medicaid
VT69717OtherBC SURGICAL
VT1014349Medicaid
VT0024685Medicare PIN