1558412163 NPI number — LEWIS COUNTY

Table of content: (NPI 1558412163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558412163 NPI number — LEWIS COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEWIS COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
L.C. PUBLIC HEALTH-EARLY INTERVENTION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558412163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7785 N STATE ST
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
LOWVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13367-1229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-376-5453
Provider Business Mailing Address Fax Number:
315-376-7013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7785 N STATE ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
LOWVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13367-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-376-5453
Provider Business Practice Location Address Fax Number:
315-376-7013
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WAITE
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PUBLIC HEALTH DIRECTOR
Authorized Official Telephone Number:
315-376-5453

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00583688 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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