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General NPI Number Information
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NPI Number | 1689678963
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH CENTERS OF BURLINGTON INC
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Dates
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Enumeration Date | 06/02/2005
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Last Update Date | 02/24/2020
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Provider Practice Location Address
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Address Line | 617 RIVERSIDE AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-1601
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Country | US
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Telephone | 802-264-8159
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Fax | 802-860-4325
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Provider Business Mailing Address
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Address Line | 617 RIVERSIDE AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-1601
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Country | US
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Telephone | 802-264-8159
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Fax | 802-860-4324
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Authorized Official
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Title or Position | INTERIM CHIEF EXECUTIVE OFFICER
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Name | KATE REED
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Credential |
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Telephone | 802-264-8190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24908
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License Number State | VT
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