Basic Information
| Provider Information | |||||||||
| NPI: | 1205873486 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF VERMONT MEDICAL CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 COLCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054011473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028472345 | ||||||||
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| Practice Location | |||||||||
| Address1: | 790 COLLEGE PKWY | ||||||||
| Address2: | |||||||||
| City: | COLCHESTER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054463007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028472345 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 11/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | VINCENT | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | INTERIM CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8028472089 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UNIVERSITY OF VERMONT MEDICAL CENTER INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | 668 | VT | Y | Hospital Units | Rehabilitation Unit |
ID Information
| ID | Type | State | Issuer | Description | 047T003 | 05 | VT | MEDICAID | 470203 | 01 | VT | REHAB UNIT | OTHER |