=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265578777
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PORTER HOSPITAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 02/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 PORTER DRIVE
-----------------------------------------------------
City | MIDDLEBURY
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-388-4701
-----------------------------------------------------
Fax | 802-388-5654
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 PORTER DRIVE C O SUSAN SPITZNER
-----------------------------------------------------
City | MIDDLEBURY
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-388-5607
-----------------------------------------------------
Fax | 802-388-5654
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | STEVEN T CIAMPA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 802-388-4752
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number | 691
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------