Healthcare Provider Details

I. General information

NPI: 1699304972
Provider Name (Legal Business Name): OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 W MAIN ST
BATAVIA NY
14020-1347
US

IV. Provider business mailing address

300 WEST AVE
BROCKPORT NY
14420-1118
US

V. Phone/Fax

Practice location:
  • Phone: 585-599-6446
  • Fax: 585-599-3166
Mailing address:
  • Phone: 585-637-3905
  • Fax: 585-637-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: PAMELA A KELLER
Title or Position: CIO/DIRECTOR PATIENT ACCOUNTS
Credential:
Phone: 585-637-3905