Healthcare Provider Details

I. General information

NPI: 1962598797
Provider Name (Legal Business Name): PORTER HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PORTER DR PORTER HOSPITAL
MIDDLEBURY VT
05753
US

IV. Provider business mailing address

115 PORTER DR FINANCE DEPT
MIDDLEBURY VT
05753
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-5682
  • Fax: 802-388-5696
Mailing address:
  • Phone: 802-388-5682
  • Fax: 802-388-5696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number675
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number867
License Number StateVT

VIII. Authorized Official

Name: JENNIFER BERTRAND
Title or Position: CFO
Credential:
Phone: 802-388-4752