Fletcher Allen Health Care, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

668 Issued in VT

Legal business name

FLETCHER ALLEN HEALTH CARE, INC

Practice address

Sugarbush Access Road
Warren, VT 05674

Phone

(802) 847-1882

Fax

(802) 847-9317

NPI assigned

Oct 23, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Roger Deshaise

Title

Chief Financial Officer

Phone

(802) 847-5911

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711584000000",
    "number": "1154404283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1063",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054021063",
            "telephone_number": "802-847-1882",
            "fax_number": "802-847-9317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SUGARBUSH ACCESS ROAD",
            "city": "WARREN",
            "state": "VT",
            "postal_code": "05674",
            "telephone_number": "802-847-1882",
            "fax_number": "802-847-9317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLETCHER ALLEN HEALTH CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A",
        "authorized_official_last_name": "DESHAISE",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "802-847-5911",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "VT",
            "license": "668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "esmd.cioxhealth.com and OID is '2.16.840.1.113883.3.6635.1.1'",
            "affiliationName": "Ciox Health",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "925 N Point Pkwy",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300055210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Molly Clark
• Stanley E. Grzyb, MD
• Katrine Kirk, PSYCHOLOGIST-MASTER
• Jefferson Lu
• Andrea Lynn Lutz, CCC/SLP
• Melissa M Marks, LMT, MMP, NCTMB

• Durable Medical Equipment & Medical Supplies in Warren, VT
• Providers in Warren, VT by specialty
• Durable Medical Equipment & Medical Supplies in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; 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.