| Blue Spruce Health Pllc | |
|
401 E Main St Newport VT 05855-5890 | |
| (802) 500-6923 | |
| Not Available |
| Full Name | Blue Spruce Health Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 401 E Main St, Newport, Vermont |
| Authorized Official Name and Position | Mohammad Umair Malik (CEO/OWNER) |
| Authorized Official Contact | 8025006923 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Spruce Health Pllc 401 E Main St Newport VT 05855-5890 Ph: (802) 500-6923 | Blue Spruce Health Pllc 401 E Main St Newport VT 05855-5890 Ph: (802) 500-6923 |
| NPI Number | 1255053211 |
|---|---|
| Provider Enumeration Date | 09/16/2022 |
| Last Update Date | 07/16/2024 |
| Medicare PECOS PAC ID | 9133560550 |
|---|---|
| Medicare Enrollment ID | O20240515003334 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255053211 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Johannah Marie Cacio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659914836 PECOS PAC ID: 3375998776 Enrollment ID: I20240515003439 |
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