Basic Information
Provider Information | |||||||||
NPI: | 1285816470 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | LAMOILLE HEALTH PARTNERS, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 749 | ||||||||
Address2: |   | ||||||||
City: | MORRISVILLE | ||||||||
State: | VT | ||||||||
PostalCode: | 056610749 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8028518600 | ||||||||
FaxNumber: | 8028518716 | ||||||||
Practice Location | |||||||||
Address1: | 609 WASHINGTON HWY | ||||||||
Address2: |   | ||||||||
City: | MORRISVILLE | ||||||||
State: | VT | ||||||||
PostalCode: | 056618652 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8028518608 | ||||||||
FaxNumber: | 8028518313 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/29/2007 | ||||||||
LastUpdateDate: | 01/27/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MAY | ||||||||
AuthorizedOfficialFirstName: | STUART | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
AuthorizedOfficialTelephone: | 8028880901 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/27/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
ID | Type | State | Issuer | Description | 0471820 | 05 | VT |   | MEDICAID | 0471823 | 05 | VT |   | MEDICAID | 0471819 | 05 | VT |   | MEDICAID | 0471821 | 05 | VT |   | MEDICAID |