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General NPI Number Information
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NPI Number | 1780969345
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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 | 10/14/2011
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 1 GENERAL WING RD
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City | RUTLAND
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State | VT
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Zip | 05701-4681
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Country | US
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Telephone | 802-773-9131
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Fax | 802-773-1551
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Provider Business Mailing Address
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Address Line | 71 ALLEN ST SUITE 101
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City | RUTLAND
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State | VT
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Zip | 05701-4570
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Country | US
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Telephone | 800-468-9118
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Fax | 802-772-7973
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Authorized Official
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Title or Position | FINANCE DIRECTOR
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Name | MICHAEL GARDNER
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Credential |
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Telephone | 802-855-2083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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