| Port City Family Medicine P.c. Inc | |
|
33 E Schuyler St Oswego NY 13126-1161 | |
| (315) 343-6974 | |
| (315) 342-3625 |
| Full Name | Port City Family Medicine P.c. Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 33 E Schuyler St, Oswego, New York |
| Authorized Official Name and Position | Corliss Adam Varnum (PRESIDENT) |
| Authorized Official Contact | 3153436974 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Port City Family Medicine P.c. Inc 33 E Schuyler St Oswego NY 13126-1161 Ph: (315) 343-6974 | Port City Family Medicine P.c. Inc 33 E Schuyler St Oswego NY 13126-1161 Ph: (315) 343-6974 |
| NPI Number | 1215028055 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 03/15/2019 |
| Medicare PECOS PAC ID | 2567350606 |
|---|---|
| Medicare Enrollment ID | O20040309001101 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215028055 | NPI | - | NPPES |
| 00964989 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Secondary |
| Provider Name | Matthew J Liepke |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245220656 PECOS PAC ID: 9739136466 Enrollment ID: I20050405001054 |
| Provider Name | Christina M Liepke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942290358 PECOS PAC ID: 2062479264 Enrollment ID: I20050425000728 |
| Provider Name | Rebecca Jo Bigness |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992322069 PECOS PAC ID: 0345633517 Enrollment ID: I20220210002060 |
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