Basic Information
| Provider Information | |||||||||
| NPI: | 1730330762 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT J JAUCH, MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 714 BREEZY HILL RD | ||||||||
| Address2: | |||||||||
| City: | ST JOHNSBURY | ||||||||
| State: | VT | ||||||||
| PostalCode: | 058198882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027485126 | ||||||||
| FaxNumber: | 8027481107 | ||||||||
| Practice Location | |||||||||
| Address1: | 714 BREEZY HILL RD | ||||||||
| Address2: | |||||||||
| City: | ST JOHNSBURY | ||||||||
| State: | VT | ||||||||
| PostalCode: | 058198882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027485126 | ||||||||
| FaxNumber: | 8027481107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2008 | ||||||||
| LastUpdateDate: | 10/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | JAUCH | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8027485126 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 008425846 | VT | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 207Y00000X | 420006154 | VT | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | VT7982 | 01 | VT | MEDICARE | OTHER | 04PO12 | 01 | VT | MVP | OTHER | 0925477 | 01 | VT | CIGNA | OTHER | 0100833Y0VT01 | 01 | NH | ANTHEM NEW HAMPSHIRE BLUE SHIELD | OTHER | 99007982 | 05 | NH | MEDICAID | 0007982 | 05 | VT | MEDICAID | 1047982 | 01 | VT | VERMONT BLUE CROSS & BLUE SHIELD | OTHER |