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General NPI Number Information
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NPI Number | 1124161088
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Entity Type | Organization
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Legal Business Name | C.M.I.S.S., PC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 311 TURNER ST SUITE 216
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City | UTICA
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State | NY
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Zip | 13501
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Country | US
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Telephone | 315-797-1340
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Fax | 315-797-2403
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Provider Business Mailing Address
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Address Line | 311 TURNER ST SUITE 216
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City | UTICA
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State | NY
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Zip | 13501
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Country | US
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Telephone | 315-797-1340
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Fax | 315-797-2403
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | M A
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Credential |
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Telephone | 315-797-1340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 176944
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License Number State | NY
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