1588758635 NPI number — COLUMBIA COUNTY

Table of content: (NPI 1588758635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588758635 NPI number — COLUMBIA COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA 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:
COLUMBIA COUNTY DEPARTMENT OF HEALTH
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:
1588758635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 COLUMBIA ST
Provider Second Line Business Mailing Address:
1ST FLOOR
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12534-1905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-828-3358
Provider Business Mailing Address Fax Number:
518-828-5894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 COLUMBIA ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12534-1905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-828-3358
Provider Business Practice Location Address Fax Number:
518-828-5894
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TIMOTHY
Authorized Official First Name:
ANGELLA
Authorized Official Middle Name:
Authorized Official Title or Position:
PUBLIC HEALTH DIRECTOR
Authorized Official Telephone Number:
518-828-3358

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1001601 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10002521 . This is a "CAPITAL DISTRICT PHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00473258 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2301493 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000400261001 . This is a "BLUE SHIELD NENY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 986047 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000013641 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004569 . This is a "EMPIRE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000400261001 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040401000513 . This is a "FIDELIS CARE OF NY" identifier . This identifiers is of the category "OTHER".




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