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SCH470024-03 Northwestern Medical Center, Inc. (Active)
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Main Details
Name
Northwestern Medical Center, Inc.
Subdivision Name
NORTHWESTERN ASSOCIATES IN SURGERY
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH470024-03
Medicare Provider Number
470024
Outpatient Facility Provider Number
024685
Additional Details
Current Program Status
Active
Registration Date
4/15/2014
Participating Start Date
7/1/2014
Participating Approval Date
5/13/2014
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Northwestern Medical Center, Inc.
Stephanie Alicia Breault, CFO
(802) 524-8823
Primary Contact
Northwestern Medical Center
Jessica Aboelezz, Director of Pharmacy
(802) 524-8878
Addresses
Street Address
1 Crest Road
St. Albans, VT 05478
Billing Address
Northwestern Medical Center Inc.
133 Fairfield Street
St. Albans, VT 05478
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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