Provider Demographics
NPI:1174528640
Name:YANKEE MEDICAL INC
Entity type:Organization
Organization Name:YANKEE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:FICOCIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:802-863-4591
Mailing Address - Street 1:276 NORTH AVENUE
Mailing Address - Street 2:PO BOX 1486
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1486
Mailing Address - Country:US
Mailing Address - Phone:802-863-4591
Mailing Address - Fax:802-658-3101
Practice Address - Street 1:276 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-2918
Practice Address - Country:US
Practice Address - Phone:802-863-4591
Practice Address - Fax:802-658-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTYAV7330OtherDME/BCBS
NH99007330Medicaid
VT1505OtherDME/MVP
NH1200915YONH01OtherDME/BCBS OF NH
VT0007330Medicaid
MA7502028Medicaid
NY00358269Medicaid
VT=========OtherDME/OTHER INSURANCES
VT0007330Medicaid