1245917871 NPI number — HUDSON HEADWATERS HEALTH NETWORK

Table of content: (NPI 1245917871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245917871 NPI number — HUDSON HEADWATERS HEALTH NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUDSON HEADWATERS HEALTH NETWORK
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:
6
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:
1245917871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 S POLK ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79101-1436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-242-7782
Provider Business Mailing Address Fax Number:
518-478-6264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 ROUTE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GANSEVOORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-291-9195
Provider Business Practice Location Address Fax Number:
518-478-6264
Provider Enumeration Date:
07/05/2023

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT PHARMACY SERVICES
Authorized Official Telephone Number:
806-242-7782

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08089521 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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