Provider Demographics
NPI:1134449069
Name:BLUE COLLAR MEDICINE
Entity type:Organization
Organization Name:BLUE COLLAR MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:802-272-9470
Mailing Address - Street 1:34 WILLEY ST
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-2500
Mailing Address - Country:US
Mailing Address - Phone:802-272-9470
Mailing Address - Fax:
Practice Address - Street 1:34 WILLEY ST
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-2500
Practice Address - Country:US
Practice Address - Phone:802-272-9470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0006673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty