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3384 Church St Alexander NY 14005-9629 | |
(585) 599-6446 | |
(585) 599-3166 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3384 Church St, Alexander, New York |
Authorized Official Name and Position | Pamela A Keller (CIO/DIRECTOR PATIENT ACCOUNTS) |
Authorized Official Contact | 5856373905 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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300 West Ave Brockport NY 14420-1118 Ph: (585) 637-3905 | 3384 Church St Alexander NY 14005-9629 Ph: (585) 599-6446 |
NPI Number | 1093344350 |
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Provider Enumeration Date | 04/07/2020 |
Last Update Date | 04/07/2020 |
Medicare PECOS PAC ID | 5496746927 |
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Medicare Enrollment ID | O20200730002566 |
Identifier | Type | State | Issuer |
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1093344350 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |