Healthcare Provider Details

I. General information

NPI: 1023049830
Provider Name (Legal Business Name): QC-MEDI NEW YORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 USHERS RD
BALLSTON LAKE NY
12019-1515
US

IV. Provider business mailing address

6330 SPRINT PKWY STE 300
OVERLAND PARK KS
66211-1157
US

V. Phone/Fax

Practice location:
  • Phone: 518-899-1158
  • Fax: 518-899-7008
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHN NICHOLS
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 518-899-1158