Healthcare Provider Details

I. General information

NPI: 1760773774
Provider Name (Legal Business Name): NORTHEASTERN VERMONT REGIONAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 HOSPITAL DR
ST JOHNSBURY VT
05819-9210
US

IV. Provider business mailing address

PO BOX 905
ST JOHNSBURY VT
05819-0905
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-8141
  • Fax:
Mailing address:
  • Phone: 802-748-8141
  • Fax: 802-748-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number753
License Number StateVT

VIII. Authorized Official

Name: ANDRE BISSONNETTE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 802-748-7520