Basic Information
| Provider Information | |||||||||
| NPI: | 1538293469 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWESTERN MEDICAL CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 FAIRFIELD ST | ||||||||
| Address2: | |||||||||
| City: | SAINT ALBANS | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054781726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8025245911 | ||||||||
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| Address1: | 133 FAIRFIELD ST | ||||||||
| Address2: | |||||||||
| City: | SAINT ALBANS | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8025245911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 07/27/2018 | ||||||||
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| AuthorizedOfficialLastName: | PIGEON | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PAYOR CREDENTIALING & CONTRACT SPEC | ||||||||
| AuthorizedOfficialTelephone: | 8025248954 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 690 | VT | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | C26350 | 01 | VT | RR TRAVELERS | OTHER | VT5818 | 05 | VT | MEDICAID |