Provider Demographics
NPI:1811036783
Name:WINDSOR HOSPITAL CORP
Entity Type:Organization
Organization Name:WINDSOR HOSPITAL CORP
Other - Org Name:MT ASCUTNEY PHYSICIANS LADIES FIRST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROV INS ENROLL COORD
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARTANIUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-674-7170
Mailing Address - Street 1:289 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:VT
Mailing Address - Zip Code:05089-9000
Mailing Address - Country:US
Mailing Address - Phone:802-674-7300
Mailing Address - Fax:802-674-7314
Practice Address - Street 1:289 COUNTY RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:VT
Practice Address - Zip Code:05089-9000
Practice Address - Country:US
Practice Address - Phone:802-674-7300
Practice Address - Fax:802-674-7314
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINDSOR HOSPITAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-06
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT703207Q00000X, 207R00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT8000819Medicaid