| Organization Name: | KILLINGTON MEDICAL CLINIC LLC |
| NPI Number: | 1134467038 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EDWARD OGORZALEK (VP, CHIEF FINANCIAL OFFICER) |
| Mailing Address: | 3902 Killington Rd Killington |
| State: | VT US |
| Postal Code: | 057519822 |
| Phone Number: | 8024226125 |
| Fax Number: | 8024226798 |
| NPI Enumeration Date: | 01/28/2013 |
| NPI Last Update Date: | 01/28/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | L0038157 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |