| State Of Vermont | |
|
108 Cherry St Burlington VT 05401-4295 | |
| (802) 863-7338 | |
| (802) 863-7635 |
| Full Name | State Of Vermont |
|---|---|
| Speciality | Clinic/center - Public Health, State Or Local |
| Location | 108 Cherry St, Burlington, Vermont |
| Authorized Official Name and Position | Patrick Burke (FEDERAL PROGRAMS ADMINISTRATOR) |
| Authorized Official Contact | 8028637257 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of Vermont Po Box 70 Burlington VT 05402-0070 Ph: (802) 863-7338 | State Of Vermont 108 Cherry St Burlington VT 05401-4295 Ph: (802) 863-7338 |
| NPI Number | 1164542361 |
|---|---|
| Provider Enumeration Date | 03/30/2007 |
| Last Update Date | 07/30/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164542361 | NPI | - | NPPES |
| 0005099 | Medicaid | VT | |
| 1002536 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP0905X | Clinic/center - Public Health, State Or Local | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
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