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General NPI Number Information
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NPI Number | 1508572348
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Entity Type | Organization
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Legal Business Name | BRIDGES HEALTHCARE LLC
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 145 PINE HAVEN SHORES RD STE 1000-54
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City | SHELBURNE
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State | VT
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Zip | 05482-7703
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Country | US
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Telephone | 802-307-9998
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Fax | 352-353-0910
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Provider Business Mailing Address
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Address Line | 861 WILLISTON RD STE 8
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-5724
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Country | US
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Telephone | 802-307-9998
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Fax | 352-353-0910
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | GEORGE VANA IV
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Credential | MD
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Telephone | 802-307-9998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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