Provider Demographics
NPI:1295774842
Name:COPLEY HOSPITAL, INC.
Entity type:Organization
Organization Name:COPLEY HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-888-8888
Mailing Address - Street 1:528 WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8973
Mailing Address - Country:US
Mailing Address - Phone:802-888-8888
Mailing Address - Fax:
Practice Address - Street 1:528 WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8973
Practice Address - Country:US
Practice Address - Phone:802-888-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COPLEY HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-06
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT667282NC0060X
207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00005776OtherBLUE CROSS
VT0005776Medicaid
VT00005776OtherBLUE CROSS