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General NPI Number Information
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NPI Number | 1437364759
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC.
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/01/2019
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Provider Practice Location Address
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Address Line | 69 ALLEN ST STE 10
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City | RUTLAND
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State | VT
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Zip | 05701-4564
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Country | US
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Telephone | 802-774-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 275 ROUTE 30 N
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City | BOMOSEEN
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State | VT
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Zip | 05732-9647
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Country | US
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Telephone | 802-468-5641
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Fax | 802-468-2923
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GRANT WHITMER
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Credential |
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Telephone | 802-468-5641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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