Organization
COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC.
Active
Other names
CHCRR Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL GARDNER (FINANCE DIRECTOR)
(802) 855-2083
Entity
Organization
Contact information
Practice address
1 GENERAL WING RD, RUTLAND, VT 05701-4681
(802) 773-9131
(802) 773-1551
Mailing address
71 ALLEN ST, SUITE 101, RUTLAND, VT 05701-4570
(800) 468-9118
(802) 772-7973
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03891774
—
NY
05
—
0471842
—
VT
05
—
1019786
—
VT
Enumeration date
10/14/2011
Last updated
01/18/2017
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