1255772729 NPI number — PRIMARY CARE HEALTH PARTNERS-ADIRONDACK LLC

Table of content: (NPI 1255772729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255772729 NPI number — PRIMARY CARE HEALTH PARTNERS-ADIRONDACK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY CARE HEALTH PARTNERS-ADIRONDACK 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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1255772729
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 KNIGHT LN STE 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLISTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05495-9308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-872-4327
Provider Business Mailing Address Fax Number:
802-288-1144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
159 MARGARET ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-1874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-562-0151
Provider Business Practice Location Address Fax Number:
518-562-2718
Provider Enumeration Date:
07/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ASSELIN
Authorized Official First Name:
JON
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICIER
Authorized Official Telephone Number:
802-872-4326

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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