| Port Jervis Family Health Np Pc | |
|
1 Cole St Port Jervis NY 12771-2217 | |
| (845) 856-6671 | |
| (845) 856-6671 |
| Full Name | Port Jervis Family Health Np Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1 Cole St, Port Jervis, New York |
| Authorized Official Name and Position | Michele M Doyle (NURSE PRACTITIONER/OWNER) |
| Authorized Official Contact | 8458566671 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Port Jervis Family Health Np Pc 7 Surrey Rd Chester NY 10918-1106 Ph: (845) 325-8378 | Port Jervis Family Health Np Pc 1 Cole St Port Jervis NY 12771-2217 Ph: (845) 856-6671 |
| NPI Number | 1063927358 |
|---|---|
| Provider Enumeration Date | 12/08/2017 |
| Last Update Date | 07/09/2020 |
| Medicare PECOS PAC ID | 3971950387 |
|---|---|
| Medicare Enrollment ID | O20231107001544 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063927358 | NPI | - | NPPES |
| 1902344492 | Medicaid | NY | |
| 1035162650001 | Medicaid | PA | |
| 1942551890 | Medicaid | NY | |
| 05103104 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 337610 (New York) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Michele M Doyle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942551890 PECOS PAC ID: 2062736325 Enrollment ID: I20150115001806 |
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