1578539607 NPI number — WYOMING COUNTY COUNTY OF WYOMING

Table of content: (NPI 1578539607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578539607 NPI number — WYOMING COUNTY COUNTY OF WYOMING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WYOMING COUNTY COUNTY OF WYOMING
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:
1578539607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5362 MUNGERS MILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRINGS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14550-9704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-786-8838
Provider Business Mailing Address Fax Number:
585-786-8840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5362 MUNGERS MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14550-9704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-786-8838
Provider Business Practice Location Address Fax Number:
585-786-8840
Provider Enumeration Date:
02/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROCHE
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF NRUSING
Authorized Official Telephone Number:
585-786-8838

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  6027600 , 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)

  • Identifier: 8351463 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P0101050WW . This is a "BLUE CHOICE ROCHESTER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00011247402 . This is a "UNIVERA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: WW . This is a "BLUE CROSS ROCHESTER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00011247401 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00356107 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103334C1 . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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