Provider Demographics
NPI:1760601256
Name:VERMONT STATE COLLEGES
Entity Type:Organization
Organization Name:VERMONT STATE COLLEGES
Other - Org Name:LYNDON STATE COLLEGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR ACCOUNTING SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-626-6200
Mailing Address - Street 1:LYNDON STATE COLLEGE
Mailing Address - Street 2:1001 COLLEGE ROAD
Mailing Address - City:LYNDONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05851
Mailing Address - Country:US
Mailing Address - Phone:802-626-6440
Mailing Address - Fax:802-626-6387
Practice Address - Street 1:LYNDON STATE COLLEGE
Practice Address - Street 2:1001 COLLEGE ROAD
Practice Address - City:LYNDONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05851
Practice Address - Country:US
Practice Address - Phone:802-626-6440
Practice Address - Fax:802-626-6387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT37048149OtherBLUE CROSS BLUE SHIELD
VT1007076Medicaid