Bennington Family Practice PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BENNINGTON FAMILY PRACTICE PLLC

Practice address

339 Dewey St
Bennington, VT 05201-2253

Phone

(802) 447-1191

Fax

(802) 442-6614

NPI assigned

May 8, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Elizabeth J Ellingsen, MHA

Title

Practice Manager

Phone

(802) 447-1191

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443484800000",
    "number": "1700835741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 DEWEY ST",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "052012253",
            "telephone_number": "802-447-1191",
            "fax_number": "802-442-6614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 DEWEY ST",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "052012253",
            "telephone_number": "802-447-1191",
            "fax_number": "802-442-6614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENNINGTON FAMILY PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2015-09-29",
        "status": "A",
        "authorized_official_last_name": "ELLINGSEN",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "802-447-1191",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8000038",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "701100449",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2015; 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.