Healthcare Provider Details

I. General information

NPI: 1295792745
Provider Name (Legal Business Name): PRIMARY CARE HEALTH PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 TIMBER LN
S BURLINGTON VT
05403-5201
US

IV. Provider business mailing address

66 KNIGHT LN STE 10
WILLISTON VT
05495-9308
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-0521
  • Fax: 802-864-6475
Mailing address:
  • Phone: 802-872-4343
  • Fax: 802-288-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JON W ASSELIN
Title or Position: COO
Credential:
Phone: 802-872-4326