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NPI Code Detail

MEDICARE: GIFFORD HEALTH CARE, INC

MEDICARE: GIFFORD HEALTH CARE, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)VT

General Provider Information

NPI Number : 1073943999
Entity Type Code : Organization
Provider Name (Legal Business Name) : GIFFORD HEALTH CARE, INC
Provider Business Mailing Address
First Line : 44 S MAIN ST
Second Line :
City : RANDOLPH
State : VT
Zip : 05060-1381
Country : US
Telephone Number : 802-728-7000
Fax Number : 802-728-4245
Provider Business Practice Location Address
First Line : 108 N MAIN ST
Second Line :
City : WHITE RIVER JUNCTION
State : VT
Zip : 05001-7056
Country : US
Telephone Number : 802-296-7370
Fax Number : 802-296-7174
Authorized Official
Title or Position : CEO
Name : MICHAEL K COSTA
Credential :
Telephone Number : 802-728-2211
Provider Enumeration Date : 11/13/2013
Last Update Date : 07/01/2025

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