Provider Demographics
NPI:1669532370
Name:BRATTLEBORO EMERGENCY SERVICES
Entity type:Organization
Organization Name:BRATTLEBORO EMERGENCY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGE R
Authorized Official - Prefix:MS
Authorized Official - First Name:REINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-257-8203
Mailing Address - Street 1:17 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6613
Mailing Address - Country:US
Mailing Address - Phone:802-257-8382
Mailing Address - Fax:802-251-8466
Practice Address - Street 1:17 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6613
Practice Address - Country:US
Practice Address - Phone:802-257-8382
Practice Address - Fax:802-251-8466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0470011Medicaid