Healthcare Provider Details

I. General information

NPI: 1285687616
Provider Name (Legal Business Name): PRIMARY CARE HEALTH PARTNERS - VERMONT LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BLAIR PARK RD STE 285
WILLISTON VT
05495-7586
US

IV. Provider business mailing address

600 BLAIR PARK RD STE 285
WILLISTON VT
05495-7586
US

V. Phone/Fax

Practice location:
  • Phone: 802-288-1140
  • Fax: 802-288-1144
Mailing address:
  • Phone: 802-288-1140
  • Fax: 802-288-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JON W ASSELIN
Title or Position: COO
Credential:
Phone: 802-872-4326