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
1	261QF0400X	Federally Qualified Health Center (FQHC)		VT

General Provider Information

NPI Number	:	1184054009
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	:	2418 AIRPORT RD STE 1
Second Line	:
City	:	BARRE
State	:	VT
Zip	:	05641-8702
Country	:	US
Telephone Number	:	802-229-2325
Fax Number	:	802-229-4572

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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