Healthcare Provider Details

I. General information

NPI: 1578536629
Provider Name (Legal Business Name): MOUNTAIN VALLEY HEALTH COUNCIL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 RT 11
LONDONDERRY VT
05148
US

IV. Provider business mailing address

38 RT 11
LONDONDERRY VT
05148
US

V. Phone/Fax

Practice location:
  • Phone: 802-824-6901
  • Fax:
Mailing address:
  • Phone: 802-824-6901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT LITCHFIELD II
Title or Position: OFFICE MANAGER
Credential:
Phone: 802-824-6901