Healthcare Provider Details

I. General information

NPI: 1346240181
Provider Name (Legal Business Name): MID-VERMONT ENT, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 ALLEN ST SUITE 4
RUTLAND VT
05701-4564
US

IV. Provider business mailing address

69 ALLEN ST SUITE 1
RUTLAND VT
05701-4564
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-3314
  • Fax: 802-775-9617
Mailing address:
  • Phone: 802-775-3314
  • Fax: 802-775-9617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateVT

VIII. Authorized Official

Name: ANN M HUGHES
Title or Position: PRACTICE MANAGER
Credential:
Phone: 802-776-7108