Healthcare Provider Details

I. General information

NPI: 1760313928
Provider Name (Legal Business Name): BLUEWATER HEALTH OF VERMONT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MAINE ST STE 306
BRUNSWICK ME
04011-2049
US

IV. Provider business mailing address

14 MAINE ST STE 306
BRUNSWICK ME
04011-2049
US

V. Phone/Fax

Practice location:
  • Phone: 207-576-3744
  • Fax: 207-560-9904
Mailing address:
  • Phone: 207-576-3744
  • Fax: 207-560-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAY W STONE
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 207-560-8481