Active NPI
Vermont State Colleges
- Family Medicine Physician
- Lyndonville, VT
National Provider Identifier
1760601256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- VERMONT STATE COLLEGES
- Practice address
- Lyndon State College
1001 College Road
Lyndonville, VT 05851 - Phone
- (802) 626-6440
- Fax
- (802) 626-6387
- NPI assigned
- Apr 24, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Robert S Bean
- Title
- Director Accounting Services
- Phone
- (802) 626-6200
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
Lyndon State College
1001 College Road
Lyndonville, VT 05851
Mailing address
Lyndon State College
1001 College Road
Lyndonville, VT 05851
Phone (802) 626-6440
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 37048149 | Other | VT | BLUE CROSS BLUE SHIELD |
| 1007076 | Medicaid | VT |
Other names 1
- Lyndon State College
National Provider Directory
National Provider Directory- Tax ID family
- Johnson State College
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Student Health Clinic/Center
- Johnson, VT
- NPI 1871719781
-
- General Practice Dentistry
- Williston, VT
- NPI 1134473218
Locations
1001 College Rd
Lyndonville, VT 05851
Phone (802) 626-6440
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1760601256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "LYNDON STATE COLLEGE",
"address_2": "1001 COLLEGE ROAD",
"city": "LYNDONVILLE",
"state": "VT",
"postal_code": "05851",
"telephone_number": "802-626-6440",
"fax_number": "802-626-6387"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "LYNDON STATE COLLEGE",
"address_2": "1001 COLLEGE ROAD",
"city": "LYNDONVILLE",
"state": "VT",
"postal_code": "05851",
"telephone_number": "802-626-6440",
"fax_number": "802-626-6387"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VERMONT STATE COLLEGES",
"organizational_subpart": "NO",
"enumeration_date": "2007-04-24",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "BEAN",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "S",
"authorized_official_title_or_position": "DIRECTOR ACCOUNTING SERVICES",
"authorized_official_telephone_number": "802-626-6200",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "37048149",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007076",
"state": "VT"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Lyndon State College",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lyndonville, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.