Healthcare Provider Details

I. General information

NPI: 1821263518
Provider Name (Legal Business Name): KENTON FAMILY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TWO MILE CREEK RD
TONAWANDA NY
14150-6618
US

IV. Provider business mailing address

300 TWO MILE CREEK RD
TONAWANDA NY
14150-6618
US

V. Phone/Fax

Practice location:
  • Phone: 716-447-6450
  • Fax:
Mailing address:
  • Phone: 716-447-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IRINA VOLKOVA
Title or Position: MD
Credential:
Phone: 716-447-6100