Healthcare Provider Details

I. General information

NPI: 1053331389
Provider Name (Legal Business Name): PORTER HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
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

104 PORTER DRIVE
MIDDLEBURY VT
05753
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-8808
  • Fax: 802-388-8322
Mailing address:
  • Phone: 802-388-8808
  • Fax: 802-388-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateNULL

VIII. Authorized Official

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