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General NPI Number Information
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NPI Number | 1811276868
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Entity Type | Organization
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Legal Business Name | CONVENIENT MEDICAL CARE
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Dates
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Enumeration Date | 08/09/2011
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Last Update Date | 08/09/2011
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Provider Practice Location Address
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Address Line | 25 N MAIN ST
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City | RUTLAND
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State | VT
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Zip | 05701-3246
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Country | US
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Telephone | 802-775-8032
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Fax | 802-775-3058
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Provider Business Mailing Address
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Address Line | 25 N MAIN ST
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City | RUTLAND
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State | VT
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Zip | 05701-3246
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Country | US
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Telephone | 802-775-8032
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Fax | 802-775-3058
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. ELISE COURCELLE BEDARD
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Credential |
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Telephone | 802-775-8032
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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 | 0420009268
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License Number State | VT
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