Healthcare Provider Details

I. General information

NPI: 1720374952
Provider Name (Legal Business Name): GIFFORD MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 09/17/2014
Certification Date:
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: 802-728-2125
  • Fax: 802-728-2143
Mailing address:
  • Phone: 802-728-2123
  • Fax: 802-728-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0270000358
License Number StateVT

VIII. Authorized Official

Name: BROOKS CHAPIN
Title or Position: DIRECTOR OF NURSING
Credential: RN
Phone: 802-728-2123