Healthcare Provider Details

I. General information

NPI: 1811080963
Provider Name (Legal Business Name): EPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 TOWNSHIP BLVD STE 10
CAMILLUS NY
13031-1677
US

IV. Provider business mailing address

260 TOWNSHIP BLVD STE 10
CAMILLUS NY
13031-1677
US

V. Phone/Fax

Practice location:
  • Phone: 315-488-3905
  • Fax: 315-488-2301
Mailing address:
  • Phone: 315-488-3905
  • Fax: 315-488-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number3301220R
License Number StateNY

VIII. Authorized Official

Name: MS. ELIZABETH M. WOOD
Title or Position: ADMINISTRATOR
Credential: RN MBA CASC
Phone: 315-488-2538