Healthcare Provider Details

I. General information

NPI: 1437765484
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

2263 STATE HIGHWAY 310
MADRID NY
13660-3224
US

IV. Provider business mailing address

214 KING ST
OGDENSBURG NY
13669-1142
US

V. Phone/Fax

Practice location:
  • Phone: 315-322-8947
  • 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