Provider Demographics
NPI:1720374952
Name:GIFFORD MEDICAL CENTER
Entity Type:Organization
Organization Name:GIFFORD MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:802-728-2123
Mailing Address - Street 1:44 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-1381
Mailing Address - Country:US
Mailing Address - Phone:802-728-2123
Mailing Address - Fax:802-728-2143
Practice Address - Street 1:44 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1381
Practice Address - Country:US
Practice Address - Phone:802-728-2125
Practice Address - Fax:802-728-2143
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENIG EXTENDED CARE FACILITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-27
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0270000358313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT475058Medicaid