Provider Demographics
NPI:1427283282
Name:MID VERMONT HEALTHCARE
Entity type:Organization
Organization Name:MID VERMONT HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:EUGAIR
Authorized Official - Suffix:
Authorized Official - Credentials:F,NP
Authorized Official - Phone:802-786-9063
Mailing Address - Street 1:69 ALLEN ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4564
Mailing Address - Country:US
Mailing Address - Phone:802-786-9063
Mailing Address - Fax:802-747-4532
Practice Address - Street 1:69 ALLEN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4564
Practice Address - Country:US
Practice Address - Phone:802-786-9063
Practice Address - Fax:802-747-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010021584363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008860Medicaid
VT500036759OtherRAILROAD MEDICARE
VT9562489OtherCIGNA
VT58743OtherBC BS OF VERMONT
VT369555OtherMVP
VT58743OtherBC BS OF VERMONT
VT500036759OtherRAILROAD MEDICARE