1689037244 NPI number — RURAL INFECTIOUS DISEASE SPECIALIST

Table of content: ULELIA CHILDS (NPI 1184503765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689037244 NPI number — RURAL INFECTIOUS DISEASE SPECIALIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RURAL INFECTIOUS DISEASE SPECIALIST
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:
1689037244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2878
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13220-2878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-279-3511
Provider Business Mailing Address Fax Number:
585-625-3855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
522 S 4TH ST STE 1700
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FULTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13069-2918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-279-3511
Provider Business Practice Location Address Fax Number:
585-625-3855
Provider Enumeration Date:
03/31/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GEORGE
Authorized Official First Name:
AVRILLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
877-279-3511

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , 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)





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