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400 Sheridan Ave Albany NY 12206-2920 | |
(518) 465-4771 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 400 Sheridan Ave, Albany, New York |
Authorized Official Name and Position | David Harold Shippee (PRESIDENT & CEO) |
Authorized Official Contact | 5185914459 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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920 Lark Drive Whitney M. Young Jr. Inc. Albany NY 12207 Ph: (518) 465-4771 | 400 Sheridan Ave Albany NY 12206-2920 Ph: (518) 465-4771 |
NPI Number | 1023381100 |
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Provider Enumeration Date | 02/20/2012 |
Last Update Date | 12/18/2018 |
Medicare PECOS PAC ID | 6507830031 |
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Medicare Enrollment ID | O20181226000587 |
Identifier | Type | State | Issuer |
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1023381100 | NPI | - | NPPES |
00473565 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 0101205R (New York) | Primary |
Memorial Hospital, Albany, N.y. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 63 Shaker Rd Ste G02, Albany, NY 12204 Phone: 518-449-5352 |