Provider Demographics
NPI:1205249893
Name:NORTHWESTERN MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:NORTHWESTERN MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CRED. SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-524-8954
Mailing Address - Street 1:1 CREST RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-9753
Mailing Address - Country:US
Mailing Address - Phone:802-524-0719
Mailing Address - Fax:802-524-8421
Practice Address - Street 1:1 CREST RD
Practice Address - Street 2:SUITE C
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9753
Practice Address - Country:US
Practice Address - Phone:802-524-0719
Practice Address - Fax:802-524-8421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT818208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty