1730171547 NPI number — UR MEDICINE HOME CARE, CERTIFIED SERVICES, INC.

Table of content: (NPI 1730171547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730171547 NPI number — UR MEDICINE HOME CARE, CERTIFIED SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UR MEDICINE HOME CARE, CERTIFIED SERVICES, INC.
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:
FINGER LAKES VISITING NURSE SERVICE
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:
1730171547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2180 EMPIRE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEBSTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14580-2029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2180 EMPIRE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEBSTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14580-2029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-787-2233
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HUTTON
Authorized Official First Name:
GREG
Authorized Official Middle Name:
T
Authorized Official Title or Position:
VP OF FINANCE
Authorized Official Telephone Number:
585-274-4225

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  2701602 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , with the licence number: 2701901L , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00355844 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5158334 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103360CI . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01155224 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P010105973 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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