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General NPI Number Information
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NPI Number | 1952702219
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Entity Type | Organization
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Legal Business Name | BROOKSIDE FAMILY HEALTH CENTER, PLLC
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 09/05/2014
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Provider Practice Location Address
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Address Line | 206 COMMERCE ST
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City | HINESBURG
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State | VT
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Zip | 05461-0416
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Country | US
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Telephone | 802-482-3900
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Fax | 802-482-4159
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Provider Business Mailing Address
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Address Line | PO BOX 416 206 COMMERCE ST
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City | HINESBURG
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State | VT
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Zip | 05461-0416
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Country | US
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Telephone | 802-482-3900
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Fax | 802-482-4159
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROGER JOSEPH GIROUX
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Credential | M.D.
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Telephone | 802-482-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 42-0008119
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License Number State | VT
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