MEDICARE: SOUTHWESTERN VERMONT MEDICAL 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	251E00000X	Home Health Agency	NO LICENSES IN VT	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	:	1811990799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWESTERN VERMONT MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	1128 MONUMENT AVE
Second Line	:
City	:	BENNINGTON
State	:	VT
Zip	:	05201-9215
Country	:	US
Telephone Number	:	802-442-5502
Fax Number	:	802-442-4919

Provider Business Practice Location Address
First Line	:	1128 MONUMENT AVE
Second Line	:
City	:	BENNINGTON
State	:	VT
Zip	:	05201-9215
Country	:	US
Telephone Number	:	802-442-5502
Fax Number	:	802-442-4919

Authorized Official
Title or Position	:	EXEC DIRECTOR
Name	:	ROBIN FRASIER
Credential	:	DPT
Telephone Number	:	802-442-5502

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/19/2013

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