Provider Demographics
NPI:1871689604
Name:PORTER HOSPITAL INC
Entity Type:Organization
Organization Name:PORTER HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:CIAMPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-388-4752
Mailing Address - Street 1:115 PORTER DR
Mailing Address - Street 2:FINANCE DEPT
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753
Mailing Address - Country:US
Mailing Address - Phone:802-388-5607
Mailing Address - Fax:802-388-5654
Practice Address - Street 1:115 PORTER DR
Practice Address - Street 2:PORTER HOSPITAL
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753
Practice Address - Country:US
Practice Address - Phone:802-388-5607
Practice Address - Fax:802-388-5654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT675207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9423Medicare UPIN