| Keith A Nichols Md, Pllc | |
|
130 Temple St Suite 100 Owego NY 13827-1408 | |
| (607) 687-5616 | |
| Not Available |
| Full Name | Keith A Nichols Md, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 130 Temple St, Owego, New York |
| Authorized Official Name and Position | Jane E Nichols (BUSINESS MANAGER) |
| Authorized Official Contact | 6076875616 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Keith A Nichols Md, Pllc 130 Temple St Suite 100 Owego NY 13827-1408 Ph: (607) 687-5616 | Keith A Nichols Md, Pllc 130 Temple St Suite 100 Owego NY 13827-1408 Ph: (607) 687-5616 |
| NPI Number | 1346421211 |
|---|---|
| Provider Enumeration Date | 11/20/2007 |
| Last Update Date | 11/20/2007 |
| Medicare PECOS PAC ID | 3779503883 |
|---|---|
| Medicare Enrollment ID | O20051205000565 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346421211 | NPI | - | NPPES |
| 00709866 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 141416-1 (New York) | Primary |
| Provider Name | Keith A Nichols |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124098785 PECOS PAC ID: 0547288094 Enrollment ID: I20051103000659 |
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