| |
1 Eastern Ave St Johnsbury VT 05819-2661 | |
(802) 748-9405 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 1 Eastern Ave, St Johnsbury, Vermont |
Authorized Official Name and Position | Meghan Elliott (HUMAN RESOURCES ASSISTANT) |
Authorized Official Contact | 8027489405 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
165 Sherman Dr St Johnsbury VT 05819-9811 Ph: (802) 748-9405 | 1 Eastern Ave St Johnsbury VT 05819-2661 Ph: (802) 748-9405 |
NPI Number | 1639783095 |
---|---|
Provider Enumeration Date | 09/03/2020 |
Last Update Date | 11/10/2020 |
Medicare PECOS PAC ID | 2860300936 |
---|---|
Medicare Enrollment ID | O20201102000284 |
Identifier | Type | State | Issuer |
---|---|---|---|
1639783095 | NPI | - | NPPES |
1009361 | Medicaid | VT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
David S Brody, Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1290 Hospital Dr, Suite 2, St Johnsbury, VT 05819 Phone: 802-748-2123 |