MEDICARE: AMBULATORY ANESTHESIA OF VERMONT, PLC

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1366690190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBULATORY ANESTHESIA OF VERMONT, PLC

Provider Business Mailing Address
First Line	:	5224 SHELBURNE RD
Second Line	:
City	:	SHELBURNE
State	:	VT
Zip	:	05482-6621
Country	:	US
Telephone Number	:	802-985-1488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 HINESBURG RD
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-7613
Country	:	US
Telephone Number	:	802-985-1488
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. EDWARD POMICTER
Credential	:	M.D.
Telephone Number	:	802-985-1488

Provider Enumeration Date	:	09/05/2008
Last Update Date	:	09/05/2008

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