| Evergreen | |
|
140 Hospital Dr Suite 215 Bennington VT 05201-5009 | |
| (802) 442-4785 | |
| Not Available |
| Full Name | Evergreen |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 140 Hospital Dr, Bennington, Vermont |
| Authorized Official Name and Position | Emil P. Miskovsky (OWNER) |
| Authorized Official Contact | 8024424785 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen 140 Hospital Dr Suite 215 Bennington VT 05201-5009 Ph: (802) 442-4785 | Evergreen 140 Hospital Dr Suite 215 Bennington VT 05201-5009 Ph: (802) 442-4785 |
| NPI Number | 1528023116 |
|---|---|
| Provider Enumeration Date | 04/18/2006 |
| Last Update Date | 06/13/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528023116 | NPI | - | NPPES |
| 1007971 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
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