Killington Medical Clinic LLC

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

License

L0038157 Issued in VT

Legal business name

KILLINGTON MEDICAL CLINIC LLC

Practice address

3902 Killington Rd
Killington, VT 05751-9822

Phone

(802) 422-6125

Fax

(802) 422-6798

NPI assigned

Jan 28, 2013

Last updated

Jan 28, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

THE RUTLAND HOSPITAL INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Edward Ogorzalek

Title

VP, Chief Financial Officer

Phone

(802) 747-1630

Specialties & licenses 1

Addresses

Part of

Rutland Hospital Inc

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359331200000",
    "number": "1134467038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 205",
            "city": "KILLINGTON",
            "state": "VT",
            "postal_code": "057510205",
            "telephone_number": "802-422-6125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3902 KILLINGTON RD",
            "city": "KILLINGTON",
            "state": "VT",
            "postal_code": "057519822",
            "telephone_number": "802-422-6125",
            "fax_number": "802-422-6798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KILLINGTON MEDICAL CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE RUTLAND HOSPITAL INC.",
        "enumeration_date": "2013-01-28",
        "last_updated": "2013-01-28",
        "status": "A",
        "authorized_official_last_name": "OGORZALEK",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "VP, CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "802-747-1630",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "VT",
            "license": "L0038157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judyann Fiumano, MS, RD, RN
• William J Knowles, ATC, CSCS
• Joan M Murray, LICSW
• Cynthia Lynn Roth, P.T.
• Gary L Roth, OTR
• James A Russell, MD

• Urgent Care Clinic/Center in Killington, VT
• Providers in Killington, VT by specialty
• Urgent Care Clinic/Center in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.