Organization
STATE OF VERMONT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK BURKE (FEDERAL PROGRAMS ADMINISTRATOR)
(802) 863-7257
Entity
Organization
Contact information
Practice address
108 CHERRY ST, BURLINGTON, VT 05401-4295
(802) 863-7338
(802) 863-7635
Mailing address
PO BOX 70, BURLINGTON, VT 05402-0070
(802) 863-7338
(802) 863-7635
Taxonomy
Speciality
Code
Description
License number
State
261QP0905X
State or Local Public Health Clinic/Center
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005099
—
VT
05
—
1002536
—
VT
Enumeration date
03/30/2007
Last updated
07/30/2008
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