| Fannie Lou Hamer | |
|
1001 Jennings St Bronx NY 10460-6032 | |
| (347) 407-7100 | |
| (718) 484-8648 |
| Full Name | Fannie Lou Hamer |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1001 Jennings St, Bronx, New York |
| Authorized Official Name and Position | Paloma Hernandez (PRESIDENT AND CEO) |
| Authorized Official Contact | 7185892440 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fannie Lou Hamer 1065 Southern Blvd Bronx NY 10459-2417 Ph: (718) 589-2440 | Fannie Lou Hamer 1001 Jennings St Bronx NY 10460-6032 Ph: (347) 407-7100 |
| NPI Number | 1023503927 |
|---|---|
| Provider Enumeration Date | 06/25/2018 |
| Last Update Date | 09/24/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023503927 | NPI | - | NPPES |
| W03211 | Other | NY | OSCAR |
| 02994952 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 02994952 (New York) | Primary |
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