Healthcare Provider Details

I. General information

NPI: 1548302862
Provider Name (Legal Business Name): PORTER HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 PORTER DR
MIDDLEBURY VT
05753-8527
US

IV. Provider business mailing address

104 PORTER DR
MIDDLEBURY VT
05753-8527
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-6347
  • Fax: 802-388-4904
Mailing address:
  • Phone: 802-388-5682
  • Fax: 802-388-5692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateVT

VIII. Authorized Official

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