Healthcare Provider Details

I. General information

NPI: 1174587927
Provider Name (Legal Business Name): RUTLAND HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ALLEN ST
RUTLAND VT
05701-4560
US

IV. Provider business mailing address

160 ALLEN ST
RUTLAND VT
05701-4560
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-7111
  • Fax: 802-775-7214
Mailing address:
  • Phone: 802-775-7111
  • Fax: 802-775-7214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number676
License Number StateVT

VIII. Authorized Official

Name: MR. EDWARD S OGORZALEK
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 802-747-1630