Organization
COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC
Active
Other names
Shorewell Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL GARDNER (FINANCE DIRECTOR)
(802) 885-2083
Entity
Organization
Contact information
Practice address
2987 VT ROUTE 22A, SHOREHAM, VT 05770-9728
(802) 897-7000
(802) 897-7718
Mailing address
71 ALLEN ST, SUITE 101, RUTLAND, VT 05701-4570
(800) 468-9118
(802) 772-7973
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03891792
—
NY
05
—
0471844
—
VT
05
—
1021223
—
VT
Enumeration date
11/09/2012
Last updated
01/18/2017
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