Provider Demographics
NPI:1356971972
Name:VERMONT CENTER FOR REGENERATIVE MEDICINE
Entity type:Organization
Organization Name:VERMONT CENTER FOR REGENERATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-734-9455
Mailing Address - Street 1:71 KNIGHT LN STE 20
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-4514
Mailing Address - Country:US
Mailing Address - Phone:802-734-9455
Mailing Address - Fax:678-574-5605
Practice Address - Street 1:71 KNIGHT LN STE 20
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-4514
Practice Address - Country:US
Practice Address - Phone:802-734-9455
Practice Address - Fax:678-574-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty