Healthcare Provider Details

I. General information

NPI: 1285819920
Provider Name (Legal Business Name): CHAMPLAIN VALLEY BRACE AND LIMB, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 ESSEX RD SUITE 201
WILLISTON VT
05495-7555
US

IV. Provider business mailing address

1701 BROADWAY ST NE
MINNEAPOLIS MN
55413-2638
US

V. Phone/Fax

Practice location:
  • Phone: 518-907-0225
  • Fax: 518-561-5335
Mailing address:
  • Phone: 800-651-6223
  • Fax: 866-896-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN GRIGGS
Title or Position: CEO
Credential:
Phone: 407-206-0040