Healthcare Provider Details

I. General information

NPI: 1013430511
Provider Name (Legal Business Name): NORTHEASTERN VERMONT REGIONAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
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 TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number865
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERT N HERSEY
Title or Position: CFO
Credential:
Phone: 802-748-7520