Healthcare Provider Details

I. General information

NPI: 1932196078
Provider Name (Legal Business Name): WINDSOR HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 COUNTY RD
WINDSOR VT
05089-9000
US

IV. Provider business mailing address

289 COUNTY RD
WINDSOR VT
05089-9000
US

V. Phone/Fax

Practice location:
  • Phone: 802-674-7036
  • Fax: 802-674-7005
Mailing address:
  • Phone: 802-674-7218
  • Fax: 802-674-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number703
License Number StateVT

VIII. Authorized Official

Name: DAVID SANVILLE
Title or Position: CFO
Credential:
Phone: 802-674-7240