Provider Demographics
NPI:1538189865
Name:PORTER HOSPITAL INC
Entity type:Organization
Organization Name:PORTER HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:CIAMPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-388-4752
Mailing Address - Street 1:104 PORTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753
Mailing Address - Country:US
Mailing Address - Phone:802-388-5682
Mailing Address - Fax:802-388-5692
Practice Address - Street 1:1330 EXCHANGE ST
Practice Address - Street 2:MIDDLEBURY PEDIATRIC AND ADOLESCENT AND MEDICINE
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-4464
Practice Address - Country:US
Practice Address - Phone:802-388-7959
Practice Address - Fax:802-388-3380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PORTER HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-20
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006356Medicaid
VT1006356Medicaid