Healthcare Provider Details

I. General information

NPI: 1932565611
Provider Name (Legal Business Name): SPRINGFIELD HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 VT ROUTE 11
LONDONDERRY VT
05148-9555
US

IV. Provider business mailing address

25 RIDGEWOOD RD
SPRINGFIELD VT
05156-3050
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number854
License Number StateVT

VIII. Authorized Official

Name: SCOTT WHITTEMORE
Title or Position: CFO
Credential:
Phone: 802-885-7344