Basic Information
| Provider Information | |||||||||
| NPI: | 1295792745 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIMARY CARE HEALTH PARTNERS | ||||||||
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| OtherOrganizationName: | TIMBER LANE PEDIATRICS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 BLAIR PARK | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | WILLISTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054957586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028601145 | ||||||||
| FaxNumber: | 8028720282 | ||||||||
| Practice Location | |||||||||
| Address1: | 51 TIMBER LANE | ||||||||
| Address2: | |||||||||
| City: | SOUTH BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028640521 | ||||||||
| FaxNumber: | 8028646475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BYCER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 8028601145 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.