Provider Demographics
NPI:1255365029
Name:TOWN OF COLCHESTER
Entity type:Organization
Organization Name:TOWN OF COLCHESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TOWN ADMINISTARTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-654-0770
Mailing Address - Street 1:8 TURCOTTE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-1706
Mailing Address - Country:US
Mailing Address - Phone:800-488-4351
Mailing Address - Fax:
Practice Address - Street 1:835 BLAKELY RD
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-4417
Practice Address - Country:US
Practice Address - Phone:802-654-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0303341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0AM0064Medicaid
NY0369000434OtherTRIAD
VT00038242OtherBLUE CROSS BLUE SHIELD
NY0369000434OtherTRIAD
=========OtherTRICARE
CT=========OtherTRIAD