Provider Demographics
NPI:1245919661
Name:MANCHESTER MEDICAL CENTER PRIMARY CARE
Entity type:Organization
Organization Name:MANCHESTER MEDICAL CENTER PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CODER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-755-7144
Mailing Address - Street 1:34 BONNET ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-8920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 BONNET ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-8920
Practice Address - Country:US
Practice Address - Phone:802-755-7144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANCHESTER MEDICAL CENTER PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty