Healthcare Provider Details

I. General information

NPI: 1154612877
Provider Name (Legal Business Name): STOWE URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 MOUNTAIN RD
STOWE VT
05672-4678
US

IV. Provider business mailing address

394 MOUNTAIN RD
STOWE VT
05672-4678
US

V. Phone/Fax

Practice location:
  • Phone: 802-253-2211
  • Fax: 802-253-2877
Mailing address:
  • Phone: 802-253-2211
  • Fax: 802-253-2877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY FITZGERALD
Title or Position: OWNER
Credential: DO
Phone: 802-253-2211