Healthcare Provider Details

I. General information

NPI: 1417213158
Provider Name (Legal Business Name): AURELIA OSBORN FOX MEMORIAL HOSPITAL SOHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 DECATUR STREET
WORCESTER NY
12197
US

IV. Provider business mailing address

1 NORTON AVE
ONEONTA NY
13820-2629
US

V. Phone/Fax

Practice location:
  • Phone: 607-397-8783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number209421
License Number StateNY

VIII. Authorized Official

Name: TRACEY SMITH
Title or Position: STAFF ACCOUNTANT
Credential:
Phone: 607-431-5305