Provider Demographics
NPI:1881086353
Name:PORTER HOSPITAL
Entity type:Organization
Organization Name:PORTER HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:CIAMPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-388-4705
Mailing Address - Street 1:76 COURT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1419
Mailing Address - Country:US
Mailing Address - Phone:802-388-1200
Mailing Address - Fax:802-388-3566
Practice Address - Street 1:76 COURT ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1419
Practice Address - Country:US
Practice Address - Phone:802-388-1200
Practice Address - Fax:802-388-3566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT056-0000150213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1024500Medicaid
VTVN0859Medicare PIN