Organization
GIFFORD HEALTH CARE, INC
Active
Other names
Gifford Pedicatric and Adolescent Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL BENNETT (CEO)
(802) 728-2211
Entity
Organization
Contact information
Practice address
40 S MAIN ST, RANDOLPH, VT 05060
(802) 728-2420
(802) 728-2111
Mailing address
44 S MAIN ST, RANDOLPH, VT 05060-1378
(802) 728-2760
(802) 728-2716
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005699
—
VT
Enumeration date
02/19/2021
Last updated
08/03/2021
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