Basic Information
| Provider Information | |||||||||
| NPI: | 1013928068 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GIFFORD MEDICAL CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2000 | ||||||||
| Address2: | 44 SOUTH MAIN STREET | ||||||||
| City: | RANDOLPH | ||||||||
| State: | VT | ||||||||
| PostalCode: | 050602000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027287000 | ||||||||
| FaxNumber: | 8027282394 | ||||||||
| Practice Location | |||||||||
| Address1: | 44 S MAIN ST | ||||||||
| Address2: | BOX 2000 | ||||||||
| City: | RANDOLPH | ||||||||
| State: | VT | ||||||||
| PostalCode: | 050601381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027287000 | ||||||||
| FaxNumber: | 8027282394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | BENNETT | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8027282211 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GIFFORD MEDICAL CENTER | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 669 | VT | Y | Hospital Units | Medicare Defined Swing Bed Unit |
ID Information
| ID | Type | State | Issuer | Description | 047Z301 | 05 | VT | MEDICAID |