Healthcare Provider Details

I. General information

NPI: 1942538368
Provider Name (Legal Business Name): SOUTHERN TIER COMMUNITY HEALTH CENTER NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9864 LUCKEY DR
HOUGHTON NY
14744-8706
US

IV. Provider business mailing address

908 NIAGARA FALLS BLVD SUITE 208
NORTH TONAWANDA NY
14120-2019
US

V. Phone/Fax

Practice location:
  • Phone: 716-701-6831
  • Fax: 716-701-6852
Mailing address:
  • Phone: 716-692-3302
  • Fax: 716-332-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GAIL SPEEDY
Title or Position: CEO
Credential:
Phone: 716-701-6831