Healthcare Provider Details

I. General information

NPI: 1215028055
Provider Name (Legal Business Name): PORT CITY FAMILY MEDICINE P.C. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 E SCHUYLER ST
OSWEGO NY
13126-1161
US

IV. Provider business mailing address

33 E SCHUYLER ST
OSWEGO NY
13126-1161
US

V. Phone/Fax

Practice location:
  • Phone: 315-343-6974
  • Fax: 315-342-3625
Mailing address:
  • Phone: 315-343-6974
  • Fax: 315-342-3625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CORLISS ADAM VARNUM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 315-343-6974