Full Name | |
---|---|
Speciality | Family Medicine |
Location | 502 5th Ave, Owego, New York |
Authorized Official Name and Position | Angela Iacovelli (COO/CFO) |
Authorized Official Contact | 6077700025 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
346 Grand Ave Johnson City NY 13790-2558 Ph: (607) 770-0025 | 502 5th Ave Owego NY 13827-1635 Ph: (607) 687-0350 |
NPI Number | 1013197557 |
---|---|
Provider Enumeration Date | 11/13/2007 |
Last Update Date | 11/13/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1013197557 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (New York) | Primary |
Keith A Nichols Md, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 130 Temple St, Suite 100, Owego, NY 13827 Phone: 607-687-5616 | |