Organization
GREEN MOUNTAIN PROSTHETICS &
Active
Organization
GREEN MOUNTAIN PROSTHETICS &
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES B. DAVIS CPO (PRESIDENT)
(802) 253-0003
Entity
Organization
Contact information
Practice address
92 WAITES LN, STOWE, VT 05672-4431
(802) 253-0003
(802) 253-9794
Mailing address
PO BOX 1236, STOWE, VT 05672-1236
(802) 253-0003
(802) 253-9794
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009984
—
VT
01
—
4658019
CIGNA
VT
01
—
GREE59788
BLUE CROSS & BLUE SHIELD
VT
Enumeration date
03/26/2007
Last updated
11/05/2010
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