Healthcare Provider Details

I. General information

NPI: 1811503865
Provider Name (Legal Business Name): CLAXTON-HEPBURN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ST LAWRENCE AVE
HAMMOND NY
13646-3259
US

IV. Provider business mailing address

214 KING ST
OGDENSBURG NY
13669-1142
US

V. Phone/Fax

Practice location:
  • Phone: 315-324-5941
  • Fax:
Mailing address:
  • Phone: 315-393-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD DUVALL
Title or Position: CEO
Credential:
Phone: 315-713-5237