Healthcare Provider Details

I. General information

NPI: 1043513575
Provider Name (Legal Business Name): VERMONT ORTHOPAEDIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ALBERT CREE DR
RUTLAND VT
05701-4601
US

IV. Provider business mailing address

3 ALBERT CREE DR
RUTLAND VT
05701-4601
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-2937
  • Fax: 802-773-0934
Mailing address:
  • Phone: 802-775-2937
  • Fax: 802-773-0934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD OGORZALEK
Title or Position: CFO
Credential:
Phone: 802-747-1630