1982723235 NPI number — ST LAWRENCE COUNTY

Table of content: (NPI 1982723235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982723235 NPI number — ST LAWRENCE COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST LAWRENCE 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:
ST LAWRENCE COUNTY PUBLIC HEALTH L- EL SC MA
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:
1982723235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 STATE HIGHWAY 310
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13617-1476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-386-2325
Provider Business Mailing Address Fax Number:
315-386-2203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 STATE HIGHWAY 310
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13617-1476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-386-2325
Provider Business Practice Location Address Fax Number:
315-386-2203
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRIDGES
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
Authorized Official Title or Position:
FISCAL MANAGER
Authorized Official Telephone Number:
315-229-3405

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , with the licence number: 4423600 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 252Y00000X , with the licence number: 4423600 , 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: 03004588 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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