| Glenwood Gardens | |
|
41 Kestrel St Rochester NY 14613-2120 | |
| (585) 697-7130 | |
| (585) 697-7131 |
| Full Name | Glenwood Gardens |
|---|---|
| Speciality | Clinic/Center |
| Location | 41 Kestrel St, Rochester, New York |
| Authorized Official Name and Position | Bridgette Wiefling (PRESIDENT/CEO) |
| Authorized Official Contact | 5854232878 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glenwood Gardens 82 Holland Street Rochester NY 14605-2131 Ph: (585) 423-5800 | Glenwood Gardens 41 Kestrel St Rochester NY 14613-2120 Ph: (585) 697-7130 |
| NPI Number | 1437424231 |
|---|---|
| Provider Enumeration Date | 03/13/2012 |
| Last Update Date | 03/19/2012 |
| Medicare PECOS PAC ID | 8729079785 |
|---|---|
| Medicare Enrollment ID | O20120531000011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437424231 | NPI | - | NPPES |
| 6613 | Other | NY | BLUE CROSS OF ROCHESTER |
| 00384969 | Medicaid | NY | |
| G0187295590 | Other | NY | BLUE CHOICE OF ROCHESTER |
| 331838 | Other | NY | MEDICARE PART A |
| 16467A | Other | NY | MEDICARE PART B |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 2701211R (New York) | Primary |
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