Healthcare Provider Details

I. General information

NPI: 1831113331
Provider Name (Legal Business Name): SOUTHWESTERN VERMONT HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DR
BENNINGTON VT
05201-5004
US

IV. Provider business mailing address

100 HOSPITAL DR
BENNINGTON VT
05201-5004
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-6361
  • Fax: 802-447-4537
Mailing address:
  • Phone: 802-442-6361
  • Fax: 802-447-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS MARY WICKER
Title or Position: DIRECTOR
Credential:
Phone: 802-442-6361