Healthcare Provider Details

I. General information

NPI: 1407939721
Provider Name (Legal Business Name): FAMILY PRACTICE ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 NO MAIN ST SUITE 101
CAMBRIDGE VT
05444
US

IV. Provider business mailing address

PO BOX 102 272 NO MAIN ST SUITE 101
CAMBRIDGE VT
05444-0102
US

V. Phone/Fax

Practice location:
  • Phone: 802-644-5114
  • Fax: 802-644-5573
Mailing address:
  • Phone: 802-644-5114
  • Fax: 802-644-5573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN MILLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 802-644-5114