Healthcare Provider Details

I. General information

NPI: 1164003117
Provider Name (Legal Business Name): ST GERMAIN FAMILY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 ROUTE 343
MILLBROOK NY
12545-6163
US

IV. Provider business mailing address

80 ROUTE 343
MILLBROOK NY
12545-6163
US

V. Phone/Fax

Practice location:
  • Phone: 845-677-3425
  • Fax:
Mailing address:
  • Phone: 184-590-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTA ST GERMAIN
Title or Position: OWNER
Credential:
Phone: 845-677-3425