Provider Demographics
NPI:1013928068
Name:GIFFORD MEDICAL CENTER INC
Entity type:Organization
Organization Name:GIFFORD MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-728-2211
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:44 SOUTH MAIN STREET
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-2000
Mailing Address - Country:US
Mailing Address - Phone:802-728-7000
Mailing Address - Fax:802-728-2394
Practice Address - Street 1:44 S MAIN ST
Practice Address - Street 2:BOX 2000
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1381
Practice Address - Country:US
Practice Address - Phone:802-728-7000
Practice Address - Fax:802-728-2394
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIFFORD MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-11
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT669275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047Z301Medicaid
VT47Z301Medicare ID - Type UnspecifiedMEDICARE