Provider Demographics
NPI:1245366277
Name:VERMONT PHYSICIANS CLINIC
Entity type:Organization
Organization Name:VERMONT PHYSICIANS CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KRUPNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-786-9063
Mailing Address - Street 1:69 ALLEN ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4564
Mailing Address - Country:US
Mailing Address - Phone:802-786-9063
Mailing Address - Fax:802-747-4532
Practice Address - Street 1:69 ALLEN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4564
Practice Address - Country:US
Practice Address - Phone:802-786-9063
Practice Address - Fax:802-747-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTKRUP11138661OtherKURT BC BS
VTONP1198Medicaid
VT58743OtherKIM EUGAIR BC BS
VTKRUP05338662OtherDEB BC BS
VTOVN1791Medicaid
VT1008860Medicaid
VTOVN1768Medicaid
VTVERM31138660OtherGROUP BC BS
VTS62710Medicare UPIN
VTG71177Medicare UPIN
VTOVN1791Medicaid
VTP56992Medicare UPIN
VTVN1791Medicare ID - Type UnspecifiedGROUP
VTKRUP11138661OtherKURT BC BS
VTQ42999Medicare UPIN
VTVN1768Medicare ID - Type UnspecifiedKURT KRUPNICK