| Brown Square Center | |
|
322 Lake Ave Brown Square Center Rochester NY 14608-1162 | |
| (585) 254-6480 | |
| (585) 254-1092 |
| Full Name | Brown Square Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 322 Lake Ave, Rochester, New York |
| Authorized Official Name and Position | Janice Harbin (PRESIDENT/CEO) |
| Authorized Official Contact | 5854235800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brown Square Center 82 Holland St Aljhc Rochester NY 14605-2131 Ph: (585) 423-5800 | Brown Square Center 322 Lake Ave Brown Square Center Rochester NY 14608-1162 Ph: (585) 254-6480 |
| NPI Number | 1013291335 |
|---|---|
| Provider Enumeration Date | 10/05/2011 |
| Last Update Date | 10/08/2015 |
| Medicare PECOS PAC ID | 8729079785 |
|---|---|
| Medicare Enrollment ID | O20111018000444 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013291335 | NPI | - | NPPES |
| 16467A | Other | NY | MEDICARE PART B |
| 6613 | Other | NY | BLUE CROSS OF ROCHESTER |
| 331838 | Other | NY | MEDICARE PART A |
| G0187295590 | Other | NY | BLUE CHOICE OF ROCHESTER |
| 03800906 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 2701211R (New York) | Primary |
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