| |
1823 Vt Rte 107 Uppr Level Bethel VT 05032-9324 | |
(802) 234-9913 | |
(802) 234-5507 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1823 Vt Rte 107 Uppr Level, Bethel, Vermont |
Authorized Official Name and Position | Daniel Bennett (CEO) |
Authorized Official Contact | 8027282211 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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44 S Main St Randolph VT 05060-1381 Ph: (802) 728-7000 | 1823 Vt Rte 107 Uppr Level Bethel VT 05032-9324 Ph: (802) 234-9913 |
NPI Number | 1659701571 |
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Provider Enumeration Date | 11/13/2013 |
Last Update Date | 08/03/2021 |
Medicare PECOS PAC ID | 2668624982 |
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Medicare Enrollment ID | O20140409000116 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659701571 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Vermont) | Primary |