Provider Demographics
NPI:1730700469
Name:GFM HOUSE CALL PRACTICE
Entity type:Organization
Organization Name:GFM HOUSE CALL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLINE
Authorized Official - Middle Name:LOLO
Authorized Official - Last Name:LAGUERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-889-3367
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:BONDVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05340-0445
Mailing Address - Country:US
Mailing Address - Phone:561-889-3367
Mailing Address - Fax:
Practice Address - Street 1:23 STRATTON
Practice Address - Street 2:
Practice Address - City:WINHALL
Practice Address - State:VT
Practice Address - Zip Code:05340
Practice Address - Country:US
Practice Address - Phone:561-889-3367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1811354327OtherIND NPI