Full Name | |
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Speciality | Clinic/Center |
Location | 7150 Main St, Ovid, New York |
Authorized Official Name and Position | Mary Ann Zelazny (CEO) |
Authorized Official Contact | 3155319102 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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14 Maiden Ln Po Box 423 Penn Yan NY 14527-1208 Ph: (315) 531-9102 | 7150 Main St Ovid NY 14521 Ph: (315) 531-9102 |
NPI Number | 1104165349 |
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Provider Enumeration Date | 02/07/2013 |
Last Update Date | 11/19/2014 |
Medicare PECOS PAC ID | 0244251486 |
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Medicare Enrollment ID | O20131110000000 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104165349 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |