Healthcare Provider Details

I. General information

NPI: 1629010194
Provider Name (Legal Business Name): SOUTHWESTERN VERMONT MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/21/2016
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: 802-447-5370
  • Fax: 802-447-5373
Mailing address:
  • Phone: 802-447-5370
  • Fax: 802-447-5373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number0370001579
License Number StateVT

VIII. Authorized Official

Name: LAURIE LINCOLN
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARM D RPH
Phone: 802-447-5372