Healthcare Provider Details

I. General information

NPI: 1508342114
Provider Name (Legal Business Name): ACTD,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 HERCULES DR
COLCHESTER VT
05446-0544
US

IV. Provider business mailing address

593 HERCULES DR
COLCHESTER VT
05446-5993
US

V. Phone/Fax

Practice location:
  • Phone: 802-488-5350
  • Fax:
Mailing address:
  • Phone: 802-488-5350
  • Fax: 802-338-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER BARTLETT
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 802-488-5350