1003929050 NPI number — FIRST COMMUNITY CARE OF BASSETT, LLC

Table of content: (NPI 1003929050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003929050 NPI number — FIRST COMMUNITY CARE OF BASSETT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST COMMUNITY CARE OF BASSETT, LLC
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:
Provider Other Organization Name Type Code:
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:
1003929050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 NORTHPOINTE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14228-1883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-568-2236
Provider Business Mailing Address Fax Number:
716-568-2243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 COMMONS DR
Provider Second Line Business Practice Location Address:
SUITE 18
Provider Business Practice Location Address City Name:
COOPERSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13326-9516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-547-2173
Provider Business Practice Location Address Fax Number:
607-547-4111
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HORRIGAN
Authorized Official First Name:
BETTY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
716-568-2236

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 023319 , 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: 01913822 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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