Provider Demographics
NPI:1689610099
Name:RUTLAND SURGICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:RUTLAND SURGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOVRAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-775-1903
Mailing Address - Street 1:241 STRATTON ROAD
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4621
Mailing Address - Country:US
Mailing Address - Phone:802-775-1903
Mailing Address - Fax:802-775-5503
Practice Address - Street 1:241 STRATTON ROAD
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4621
Practice Address - Country:US
Practice Address - Phone:802-775-1903
Practice Address - Fax:802-775-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTRUTL00004524OtherBS
SP0281OtherMVP
VT0004524Medicaid
SP0281OtherMVP