# RUTLAND REGION COLLABORATIVE ACO, LLC

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

## Provider details

- **NPI number:** 1689949968
- **Authorized official:** MICHAEL GARDNER (FINANCE DIRECTOR)
- **Authorized official phone:** (802) 773-3386

## Contact information

- **Practice address:** 275 ROUTE 30 N, BOMOSEEN, VT 05732-9647
- **Practice address phone:** (802) 468-5641
- **Practice address fax:** (802) 468-2923
- **Mailing address:** 275 ROUTE 30 N, BOMOSEEN, VT 05732-9647
- **Mailing address phone:** (802) 468-5641
- **Mailing address fax:** (802) 468-2923

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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