Basic Information
| Provider Information | |||||||||
| NPI: | 1689678963 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HEALTH CENTERS OF BURLINGTON INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 617 RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054011601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022648159 | ||||||||
| FaxNumber: | 8028604324 | ||||||||
| Practice Location | |||||||||
| Address1: | 617 RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054011601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022648159 | ||||||||
| FaxNumber: | 8028604325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2005 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | REED | ||||||||
| AuthorizedOfficialFirstName: | KATE | ||||||||
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| AuthorizedOfficialTitleorPosition: | INTERIM CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8022648190 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 24908 | VT | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | VT4600 | 01 | VT | VERMONT MANAGED CARE | OTHER | 8000704 | 01 | VT | LADIES FIRST | OTHER | 4600 | 05 | VT | MEDICAID | VT4600 | 01 | VT | BLUE CROSS BLUE SHIELD | OTHER |