Healthcare Provider Details

I. General information

NPI: 1578650099
Provider Name (Legal Business Name): NORTHWESTERN MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 FAIRFIELD ST STE 102
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: 802-524-8911
  • Fax: 802-752-1358
Mailing address:
  • Phone: 802-524-5911
  • Fax: 802-527-1057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY E PIGEON
Title or Position: PAYOR CREDENTIALING & CONTRACT SPEC
Credential:
Phone: 802-524-8954