Healthcare Provider Details

I. General information

NPI: 1558945402
Provider Name (Legal Business Name): NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/07/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 EAST AVE
CENTRAL SQUARE NY
13036-2611
US

IV. Provider business mailing address

61 DELANO ST
PULASKI NY
13142-1400
US

V. Phone/Fax

Practice location:
  • Phone: 315-298-6569
  • Fax:
Mailing address:
  • Phone: 315-298-6569
  • Fax: 315-298-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRACY LYNNE WIMMER
Title or Position: VP/CFO
Credential:
Phone: 315-298-6569