Provider Demographics
NPI:1336251461
Name:SOJOURNS COMMUNITY CLINIC INC
Entity type:Organization
Organization Name:SOJOURNS COMMUNITY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR & BOARD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:HALTINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-722-4023
Mailing Address - Street 1:4923 US ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:VT
Mailing Address - Zip Code:05158
Mailing Address - Country:US
Mailing Address - Phone:802-722-4023
Mailing Address - Fax:802-722-4137
Practice Address - Street 1:4923 US ROUTE 5
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:VT
Practice Address - Zip Code:05158
Practice Address - Country:US
Practice Address - Phone:802-722-4023
Practice Address - Fax:802-722-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
33224OtherMVP
7108120OtherCIGNA
VT58593OtherBCBS
VT0VN2821Medicaid
VN2821Medicare ID - Type Unspecified