MEDICARE: YANKEE MEDICAL INC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	335E00000X	Prosthetic/Orthotic Supplier

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	YAV7330	OTHER	VT	DME/BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1505	OTHER	VT	DME/MVP
4	1200915YONH01	OTHER	NH	DME/BCBS OF NH
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1174528640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YANKEE MEDICAL INC

Provider Business Mailing Address
First Line	:	276 NORTH AVENUE
Second Line	:	PO BOX 1486
City	:	BURLINGTON
State	:	VT
Zip	:	05401-1486
Country	:	US
Telephone Number	:	802-863-4591
Fax Number	:	802-658-3101

Provider Business Practice Location Address
First Line	:	276 NORTH AVE
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05401-2918
Country	:	US
Telephone Number	:	802-863-4591
Fax Number	:	802-658-3101

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN NICHOLAS FICOCIELLO
Credential	:	CPO
Telephone Number	:	802-863-4591

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	05/07/2008

336 NORTH AVE
BURLINGTON, VT
05401-2918

Practice Phone: 802-864-0555
Practice Fax: