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41 Medical Village Dr Newport VT 05855-9835 | |
| (802) 334-4111 | |
| (802) 334-3281 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 41 Medical Village Dr, Newport, Vermont |
| Authorized Official Name and Position | Deborah L Brown (ENROLLMENT SPECIALIST) |
| Authorized Official Contact | 8023343210 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
189 Prouty Dr Newport VT 05855-9326 Ph: (802) 334-4111 | 41 Medical Village Dr Newport VT 05855-9835 Ph: (802) 334-4111 |
| NPI Number | 1972634889 |
|---|---|
| Provider Enumeration Date | 03/09/2007 |
| Last Update Date | 09/12/2023 |
| Certification Date | 09/12/2023 |
| Medicare PECOS PAC ID | 9739073479 |
|---|---|
| Medicare Enrollment ID | O20071203000069 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972634889 | NPI | - | NPPES |
| 30214523 | Medicaid | NH | |
| CI3697 | Other | VT | RAILROAD MEDICARE |
| 0572880002 | Other | VT | DME |
| 13842 | Other | VT | MVP |
| NORT00019682 | Other | VT | BLUE SHIELD |
| OVN0871 | Medicaid | VT | |
| 101315300 | Other | VT | DEPT OF LABOR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Alexandra Bannach |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1518953942 PECOS PAC ID: 1355649427 Enrollment ID: I20160406001867 |
| Provider Name | Tatiana B Sergeev |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1770531725 PECOS PAC ID: 0840264818 Enrollment ID: I20161024002722 |
| Provider Name | Sarah L Mcauliff |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1821482878 PECOS PAC ID: 3173879822 Enrollment ID: I20190912002660 |
| Provider Name | Jennifer L Menon |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1356616429 PECOS PAC ID: 1153544275 Enrollment ID: I20210814000039 |
Enlightened Path Counseling Services, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 15 Taylor St Ste 1, Newport, VT 05855 Phone: 802-673-9600 | |
Northeast Kingdom Human Services Inc Mh Adult Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 154 Duchess St, Newport, VT 05855 Phone: 802-334-6744 Fax: 802-334-7340 | |
Northeast Kingdom Human Services Inc Mh Children Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 154 Duchess St, Newport, VT 05855 Phone: 802-334-6744 Fax: 802-334-7340 | |
Northeast Kingdom Human Services Inc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 181 Crawford Rd, Newport, VT 05855 Phone: 802-334-6744 Fax: 802-334-7455 | |
New Insights Counseling, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 29 Colfax St, Newport, VT 05855 Phone: 802-272-6648 | |
Northern Compass Counseling Solutions Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 578 E Main St, Newport, VT 05855 Phone: 802-487-4347 | |
Northeast Kingdom Human Services Inc Mh Waiver Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 154 Duchess St, Newport, VT 05855 Phone: 802-334-6744 Fax: 802-334-7340 |