Healthcare Provider Details

I. General information

NPI: 1437281128
Provider Name (Legal Business Name): HINESBURG FAMILY HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 COMMERCE ST UNIT 10
HINESBURG VT
05461
US

IV. Provider business mailing address

PO BOX 250 22 COMMERCE ST UNIT 10
HINESBURG VT
05461
US

V. Phone/Fax

Practice location:
  • Phone: 802-482-3200
  • Fax: 802-482-5238
Mailing address:
  • Phone: 802-482-3200
  • Fax: 802-482-5238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateVT

VIII. Authorized Official

Name: MR. JOHN W REYNOLDS
Title or Position: PRESIDENT
Credential:
Phone: 802-482-3200