Healthcare Provider Details

I. General information

NPI: 1992747737
Provider Name (Legal Business Name): NORTHEASTERN VERMONT REGIONAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
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: 802-748-4098
Mailing address:
  • Phone: 802-748-8141
  • Fax: 802-748-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number673
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDRE BISSONNETTE
Title or Position: CFO
Credential:
Phone: 802-748-7520