Provider Demographics
NPI:1720042203
Name:RUTLAND HOSPITAL, INC.
Entity Type:Organization
Organization Name:RUTLAND HOSPITAL, INC.
Other - Org Name:RUTLAND REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
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:802-747-1630
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:802-747-1630
Practice Address - Fax:802-775-7214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT772273R00000X
VT676282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT48364OtherBC DIABETES PROV #
VT0004910Medicaid
VT0005713Medicaid
VT0009521Medicaid
VT5834OtherBC CARDIOLOGY PROV #
VT047W147Medicaid
NY00352429Medicaid
VT0009678Medicaid
VT4361OtherBLUE CROSS ED PROV #
VT047-0005Medicaid
VT0005384Medicaid
VT1009146Medicaid
VTVT9521Medicare ID - Type UnspecifiedPHYSIATRY PROV #
VT0009521Medicaid
VTVT4910Medicare ID - Type UnspecifiedPSYCH PROV #
NY00352429Medicaid
VT0005713Medicaid
VT0004910Medicaid