Organization
LAKES REGION HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS EDWARD BEAUREGARD PA-C (PRESIDENT)
(802) 468-8755
Entity
Organization
Contact information
Practice address
49 CASTLETON MEADOWS LN, CASTLETON, VT 05735-9011
(802) 468-8755
Mailing address
PO BOX 509, BOMOSEEN, VT 05732-0509
(802) 468-8755
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
0550030883
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000153
—
VT
Enumeration date
02/20/2008
Last updated
02/20/2008
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