Healthcare Provider Details

I. General information

NPI: 1205385069
Provider Name (Legal Business Name): ADAM MEYER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 VETERANS DR
WHITE RIVER JUNCTION VT
05009-0001
US

IV. Provider business mailing address

215 N MAIN ST
WHITE RIVER JUNCTION VT
05009-0001
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-9363
  • Fax:
Mailing address:
  • Phone: 802-295-9363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License Number007640
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number122.0000075
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: