Healthcare Provider Details

I. General information

NPI: 1033340641
Provider Name (Legal Business Name): PORTER HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 PORTER DR
MIDDLEBURY VT
05753-8527
US

IV. Provider business mailing address

108 PORTER DR
MIDDLEBURY VT
05753-8527
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-5682
  • Fax: 802-388-5692
Mailing address:
  • Phone: 802-388-7255
  • Fax: 802-388-8833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVE CIAMPA
Title or Position: CFO
Credential:
Phone: 802-388-4752