# CARLOS OTIS STRATTON MOUNTAIN CLINIC, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598124455
- **Authorized official:** MARY BETH HAND (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (802) 297-2300

## Contact information

- **Practice address:** 78 FOUNDERS HILL ROAD, STRATTON MOUNTAIN, VT 05155
- **Practice address phone:** (802) 297-2300
- **Mailing address:** 78 FOUNDERS HILL ROAD, STRATTON MOUNTAIN, VT 05155
- **Mailing address phone:** (802) 297-2300
- **Mailing address fax:** (802) 297-3412

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/19/2016
- **Last updated:** 02/19/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3016458 | VT BCBS NON PAR | — |