Basic Information
| Provider Information | |||||||||
| NPI: | 1568419976 | ||||||||
| 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: | 8028470000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 COLCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054011473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028470000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 11/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | VINCENT | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | INTERIM CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8028472089 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 668 | VT | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 001080 | 01 | EMPIRE HMO/POS | OTHER | 0470003 | 05 | RI | MEDICAID | 1729540 | 05 | LA | MEDICAID | 4458 | 01 | MVP HMO-IP | OTHER | 8000880 | 05 | VT | MEDICAID | 00353851 | 05 | NY | MEDICAID | 0306 | 01 | MVP HMO - OP | OTHER | 3053501 | 05 | WA | MEDICAID | 470003 | 01 | BC PROVIDER BILLING ID | OTHER | OP47000 | 05 | RI | MEDICAID | 10025106600 | 05 | NE | MEDICAID | 144080000 | 05 | ME | MEDICAID | 99470003 | 05 | NH | MEDICAID | 091785100 | 05 | FL | MEDICAID | 7001274 | 05 | MA | MEDICAID | 0249154 | 05 | OH | MEDICAID | 0470003 | 05 | VT | MEDICAID | 10015084 | 01 | CAPITAL DISTRICT PHYS NET | OTHER |