Provider Demographics
NPI:1285717553
Name:FLETCHER ALLEN HEALTH CARE,IN
Entity type:Organization
Organization Name:FLETCHER ALLEN HEALTH CARE,IN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHAIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-847-5911
Mailing Address - Street 1:PO BOX 1063
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05402-1063
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:792 COLLEGE PARKWAY
Practice Address - Street 2:MOB STE 101
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-0000
Practice Address - Country:US
Practice Address - Phone:802-847-1882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT668332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0947490014Medicare NSC
0947490014Medicare ID - Type Unspecified