=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508890492
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2006
-----------------------------------------------------
Last Update Date | 11/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 71 ALLEN ST SUITE 101
-----------------------------------------------------
City | RUTLAND
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05701-4570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-855-2083
-----------------------------------------------------
Fax | 802-855-2055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 71 ALLEN ST STE 101
-----------------------------------------------------
City | RUTLAND
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05701-4570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-468-9118
-----------------------------------------------------
Fax | 802-772-7973
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXEC DIRECTOR
-----------------------------------------------------
Name | GRANT L WHITMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 802-855-2083
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------