Healthcare Provider Details

I. General information

NPI: 1386689875
Provider Name (Legal Business Name): NORTHWESTERN MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 FAIRFIELD ST
SAINT ALBANS VT
05478-1726
US

IV. Provider business mailing address

133 FAIRFIELD ST
SAINT ALBANS VT
05478-1726
US

V. Phone/Fax

Practice location:
  • Phone: 802-524-1076
  • Fax: 802-524-8803
Mailing address:
  • Phone: 802-524-1076
  • Fax: 802-524-8803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number0370001670
License Number StateVT

VIII. Authorized Official

Name: MARY PIGEON
Title or Position: PAYOR CREDENTIALING SPECIALIST
Credential:
Phone: 802-524-8954