Healthcare Provider Details

I. General information

NPI: 1902990674
Provider Name (Legal Business Name): CHAMPLAIN VALLEY URGENT CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 FAYETTE DR
SOUTH BURLINGTON VT
05403-6977
US

IV. Provider business mailing address

7 FAYETTE DR
SOUTH BURLINGTON VT
05403-6977
US

V. Phone/Fax

Practice location:
  • Phone: 802-865-3655
  • Fax: 802-865-3626
Mailing address:
  • Phone: 802-865-3655
  • Fax: 802-865-3626

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: DR. TIMOTHY FITZGERALD
Title or Position: CEO
Credential: DO
Phone: 802-865-3655