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Organization
RUTLAND REGION COLLABORATIVE ACO, LLC
Active
Organization
RUTLAND REGION COLLABORATIVE ACO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL GARDNER (FINANCE DIRECTOR)
(802) 773-3386
Entity
Organization
Contact information
Practice address
275 ROUTE 30 N, BOMOSEEN, VT 05732-9647
(802) 468-5641
(802) 468-2923
Mailing address
275 ROUTE 30 N, BOMOSEEN, VT 05732-9647
(802) 468-5641
(802) 468-2923
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
NULL
104100000X
Social Worker
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
03/20/2012
Last updated
03/20/2012
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