Provider Demographics
NPI:1740291400
Name:PORTER HOSPITAL INC
Entity type:Organization
Organization Name:PORTER HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:COMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-388-4752
Mailing Address - Street 1:115 PORTER DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-8423
Mailing Address - Country:US
Mailing Address - Phone:802-388-5607
Mailing Address - Fax:802-388-5654
Practice Address - Street 1:115 PORTER DRIVE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753
Practice Address - Country:US
Practice Address - Phone:802-388-4701
Practice Address - Fax:802-388-5654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT675282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
472307OtherM CARE SWING
VT470006OtherBCBS
VT471307Medicaid
472307OtherM CARE SWING