Provider Demographics
NPI:1730151556
Name:HOUGHTON, JODY P (PAC)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:P
Last Name:HOUGHTON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:SPRINGFIELD MEDICAL CARE SYSTEMS INC
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-0710
Mailing Address - Country:US
Mailing Address - Phone:802-463-3903
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL CT
Practice Address - Street 2:
Practice Address - City:BELLOWS FALLS
Practice Address - State:VT
Practice Address - Zip Code:05101-1489
Practice Address - Country:US
Practice Address - Phone:802-463-3903
Practice Address - Fax:802-463-1287
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0550030129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000099Medicaid
S71300Medicare UPIN
VTAP0962Medicare ID - Type Unspecified
VT9000099Medicaid