Provider Demographics
NPI:1477390110
Name:MEDWAY LLC
Entity type:Organization
Organization Name:MEDWAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:607-215-3692
Mailing Address - Street 1:301 PEARL ST
Mailing Address - Street 2:SUITE 202 132
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819
Mailing Address - Country:US
Mailing Address - Phone:607-215-6392
Mailing Address - Fax:
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:3D, OFFICE E
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:607-215-6392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health