| Organization Name: | MAD RIVER INTEGRATIVE MEDICINE |
| NPI Number: | 1114086808 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIMOTHY J WARGO (PRESIDENT) |
| Mailing Address: | 5360 Main St Ste 2 Waitsfield |
| State: | VT US |
| Postal Code: | 056736003 |
| Phone Number: | 8024962202 |
| Fax Number: | 8024962223 |
| NPI Enumeration Date: | 12/08/2006 |
| NPI Last Update Date: | 04/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 042-0007289 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |