Healthcare Provider Details

I. General information

NPI: 1124114251
Provider Name (Legal Business Name): SOUTHWESTERN VERMONT MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 MONUMENT AVE
BENNINGTON VT
05201-9215
US

IV. Provider business mailing address

1128 MONUMENT AVE
BENNINGTON VT
05201-9215
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-5502
  • Fax: 802-442-4919
Mailing address:
  • Phone: 802-442-5502
  • Fax: 802-442-4919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateVT

VIII. Authorized Official

Name: ROBIN FRASIER
Title or Position: EXECUTIVE DIRECTOR
Credential: PT
Phone: 802-442-5502