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Clarence Sherman Ivie

Anesthesiology

Allopathic & Osteopathic Physicians

111 Colchester Ave, Wp-2, Burlington, VT 05401-1473

PECOS Enrollment

This provider is enrolled in PECOS as CLARENCE IVIE.

Based on the most recent information from CMS, provider Clarence Sherman Ivie is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1275585689
Provider Type
Individual
Full Name
Ivie, Clarence Sherman
Title
Dr.
Credential
D.O.

Gender
Male
Sole Proprietor
No
Enumeration Date
5/16/2006
Last Updated
5/23/2013

Contact Information

Practice Location

111 Colchester Ave, Wp-2, Burlington, VT 05401-1473

(802) 847-2415

(802) 847-2965

Mailing Location

111 Colchester Ave, Burlington, VT 05401-1473

(802) 847-2415

(802) 847-2965

Provider Taxonomies

Code	Description	License
Code 207L00000X Primary	Description Anesthesiology Allopathic & Osteopathic Physicians	License 032-0000512 Vermont

Provider Identifiers

ID	Description	Issuer
ID 1013468	Description Medicaid	Issuer Unlisted Vermont
ID VN417801	Description Other	Issuer MEDICARE Vermont

Clarence Sherman Ivie

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Grondin, Lydia S

Hoeft, Mark A.

Kristensen, Eva A

Torbin, Olga I

Meehan, Barry

Pflaum, Alexa

Gage, Jennifer Cerny

Pace, Thomas Robert

Murphy, Marian

Meisterling, Karl