| Lafargeville School Based Health Clinic | |
|
20414 Sunset Avenue Lafargeville NY 13656-2222 | |
| (315) 493-1000 | |
| (315) 493-0105 |
| Full Name | Lafargeville School Based Health Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 20414 Sunset Avenue, Lafargeville, New York |
| Authorized Official Name and Position | Richard Duvall (ADMINISTRATOR) |
| Authorized Official Contact | 3155195201 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lafargeville School Based Health Clinic 20414 Sunset Avenue Lafargeville NY 13656-2222 Ph: (315) 493-1000 | Lafargeville School Based Health Clinic 20414 Sunset Avenue Lafargeville NY 13656-2222 Ph: (315) 493-1000 |
| NPI Number | 1881926533 |
|---|---|
| Provider Enumeration Date | 02/05/2010 |
| Last Update Date | 05/05/2021 |
| Medicare PECOS PAC ID | 9931010485 |
|---|---|
| Medicare Enrollment ID | O20181220000153 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881926533 | NPI | - | NPPES |
| 05797833 | Medicaid | NY | |
| 333987 | Other | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| 261QS1000X | Clinic/center - Student Health | 2238001H (New York) | Secondary |