MEDICARE: VERMONT MEDICAL SLEEP DISORDERS CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center		VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497884209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERMONT MEDICAL SLEEP DISORDERS CENTER, INC

Provider Business Mailing Address
First Line	:	139 PEARL ST
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-3659
Country	:	US
Telephone Number	:	802-878-4445
Fax Number	:	802-878-4607

Provider Business Practice Location Address
First Line	:	139 PEARL ST
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-3659
Country	:	US
Telephone Number	:	802-878-4445
Fax Number	:	802-878-4607

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	MR. RAMON DUANE PAQUETTE
Credential	:	RPSGT
Telephone Number	:	802-878-4445

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	08/22/2020

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