| River's Edge Integrative Medicine Pllc | |
|
4374 Rt 100 Warren VT 05674-0567 | |
| (802) 744-7284 | |
| Not Available |
| Full Name | River's Edge Integrative Medicine Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4374 Rt 100, Warren, Vermont |
| Authorized Official Name and Position | Carlene Vasquez-brown (OWNER/MEMBER) |
| Authorized Official Contact | 8027447284 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| River's Edge Integrative Medicine Pllc 4372 Vermont Route 100 Warren VT 05674-9728 Ph: (603) 783-6714 | River's Edge Integrative Medicine Pllc 4374 Rt 100 Warren VT 05674-0567 Ph: (802) 744-7284 |
| NPI Number | 1639873839 |
|---|---|
| Provider Enumeration Date | 03/30/2023 |
| Last Update Date | 03/30/2023 |
| Medicare PECOS PAC ID | 4587021332 |
|---|---|
| Medicare Enrollment ID | O20230609000410 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639873839 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Carlene Vasquez-brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508199027 PECOS PAC ID: 3678611399 Enrollment ID: I20230609000600 |
| Provider Name | James Ebert |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1558372417 PECOS PAC ID: 7810903291 Enrollment ID: I20231122001620 |