Healthcare Provider Details

I. General information

NPI: 1780832378
Provider Name (Legal Business Name): SOUTHWESTERN VERMONT MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 HOSPITAL DR SUITE 207
BENNINGTON VT
05201-5009
US

IV. Provider business mailing address

140 HOSPITAL DR SUITE 207
BENNINGTON VT
05201-5009
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-6361
  • Fax:
Mailing address:
  • Phone: 802-442-6361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS LEKNOWSKI
Title or Position: CFO
Credential:
Phone: 802-442-6361