| Jericho Road Community Health Center | |
|
21 Doat Street Buffalo NY 14211-1612 | |
| (716) 892-2775 | |
| (716) 597-0554 |
| Full Name | Jericho Road Community Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 21 Doat Street, Buffalo, New York |
| Authorized Official Name and Position | Jackie Endress (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 7163483000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jericho Road Community Health Center 21 Doat Street Buffalo NY 14211-1616 Ph: (716) 892-2775 | Jericho Road Community Health Center 21 Doat Street Buffalo NY 14211-1612 Ph: (716) 892-2775 |
| NPI Number | 1619307022 |
|---|---|
| Provider Enumeration Date | 11/21/2013 |
| Last Update Date | 09/09/2021 |
| Medicare PECOS PAC ID | 5597992933 |
|---|---|
| Medicare Enrollment ID | O20131211000108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619307022 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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