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Contact Information

WINOOSKI INTEGRATIVE MEDICINE PC
321 MAIN ST STE B
WINOOSKI, VT05404-1380
 Phone: 802-636-4133
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Multi-Specialty

261QM1300X 70 Clinic or Group Practice
 

Acupuncturist

171100000X
 

Family

363LF0000X 50 Nurse Practitioner
 

Naturopath

175F00000X
 

Nurse Practitioner

363L00000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for WINOOSKI INTEGRATIVE MEDICINE PC

NPI # 1619694478
LBN Legal business name WINOOSKI INTEGRATIVE MEDICINE PC
Authorized official SAM RUSSO - (PRINCIPAL)
Entity Organization
Organization subpart 1 No
Enumeration date 10/24/2022
Last updated 02/14/2025 - More than a year ago
Identifiers
VT Medicaid 1015129
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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