Healthcare Provider Details

I. General information

NPI: 1275126260
Provider Name (Legal Business Name): NORTHEASTERN VERMONT REGIONAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 HOSPITAL DR, LOWER LEVEL
ST. JOHNSBURY VT
05819
US

IV. Provider business mailing address

PO BOX 905
ST JOHNSBURY VT
05819-0905
US

V. Phone/Fax

Practice location:
  • Phone: 802-745-6800
  • 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 Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERT N HERSEY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 802-748-7520