Provider Demographics
NPI:1952319220
Name:SOUTHERN VERMONT HEALTH SERVICES CORP
Entity Type:Organization
Organization Name:SOUTHERN VERMONT HEALTH SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PATIENT FINANCIAL SVCS
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOUDREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-257-8382
Mailing Address - Street 1:17 BELMONT AVE
Mailing Address - Street 2:ATT'N: MARILYN BOUDREAU
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:ATT'N: MARILYN BOUDREAU
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:2006-08-03
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013172Medicaid
VT1013172Medicaid