Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 40 S Main St, Randolph, 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 05060-1378 Ph: (802) 728-2760 | 40 S Main St Randolph VT 05060 Ph: (802) 728-2420 |
NPI Number | 1831782929 |
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Provider Enumeration Date | 02/19/2021 |
Last Update Date | 08/03/2021 |
Medicare PECOS PAC ID | 2668624982 |
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Medicare Enrollment ID | O20240221002701 |
Identifier | Type | State | Issuer |
---|---|---|---|
1831782929 | NPI | - | NPPES |
0005699 | Medicaid | VT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Gifford Health Care, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 44 South Main St., Randolph, VT 05060 Phone: 802-728-7000 Fax: 802-728-4245 | |