Healthcare Provider Details

I. General information

NPI: 1922763952
Provider Name (Legal Business Name): GARNET CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 RIVER ST BLDG 900
ESSEX JUNCTION VT
05452-4201
US

IV. Provider business mailing address

34 BLAIR PARK RD STE 104 BOX 327
WILLISTON VT
05495-7991
US

V. Phone/Fax

Practice location:
  • Phone: 802-876-2300
  • Fax:
Mailing address:
  • Phone: 802-876-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN FERRIS
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 802-876-2301