Provider Demographics
NPI:1679552723
Name:UNIVERSITY OF VERMONT AND STATE AGRICULTURAL COLLEGE
Entity type:Organization
Organization Name:UNIVERSITY OF VERMONT AND STATE AGRICULTURAL COLLEGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-656-8509
Mailing Address - Street 1:425 PEARL STREET
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3308
Mailing Address - Country:US
Mailing Address - Phone:802-656-8509
Mailing Address - Fax:802-656-9350
Practice Address - Street 1:284 EAST AVE STE 1
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05405-3401
Practice Address - Country:US
Practice Address - Phone:802-656-4287
Practice Address - Fax:802-656-9350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF VERMONT AND STATE AGRICULTURAL COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-16
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0314341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTAM0183Medicare PIN