# GREEN MOUNTAIN UROLOGY INC

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

## Provider details

- **NPI number:** 1730160532
- **Authorized official:** RICHARD T GRUNERT MD (PRESIDENT)
- **Authorized official phone:** (802) 655-4900

## Contact information

- **Practice address:** 792 COLLEGE PKWY, SUITE302, COLCHESTER, VT 05446-3052
- **Practice address phone:** (802) 655-4900
- **Practice address fax:** (802) 655-5017
- **Mailing address:** 792 COLLEGE PKWY, SUITE302, COLCHESTER, VT 05446-3052
- **Mailing address phone:** (802) 655-4900
- **Mailing address fax:** (802) 655-5017

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 11/08/2005
- **Last updated:** 02/25/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0VN0583 | — | VT |