Healthcare Provider Details

I. General information

NPI: 1669532370
Provider Name (Legal Business Name): BRATTLEBORO EMERGENCY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BELMONT AVE
BRATTLEBORO VT
05301-6613
US

IV. Provider business mailing address

17 BELMONT AVE
BRATTLEBORO VT
05301-6613
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-8382
  • Fax: 802-251-8466
Mailing address:
  • Phone: 802-257-8382
  • Fax: 802-251-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. REINA CHAMPNEY
Title or Position: CREDENTIALING MANAGE R
Credential:
Phone: 802-257-8203