Healthcare Provider Details

I. General information

NPI: 1750400271
Provider Name (Legal Business Name): GIFFORD MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 S MAIN ST
RANDOLPH VT
05060-1381
US

IV. Provider business mailing address

44 S MAIN ST
RANDOLPH VT
05060-1381
US

V. Phone/Fax

Practice location:
  • Phone: 802-728-7000
  • Fax: 802-728-2394
Mailing address:
  • Phone: 802-728-7000
  • Fax: 802-728-2394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number StateVT

VIII. Authorized Official

Name: MICHAEL K COSTA
Title or Position: CEO
Credential:
Phone: 802-728-2211