=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144404138
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A.O. FOX MEM LIFELINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2007
-----------------------------------------------------
Last Update Date | 12/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 NORTON AVE.
-----------------------------------------------------
City | ONEONTA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-431-5999
-----------------------------------------------------
Fax | 607-431-5212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 NORTON AVEN.
-----------------------------------------------------
City | ONEONTA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-431-5999
-----------------------------------------------------
Fax | 607-431-5212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT, FINANCE
-----------------------------------------------------
Name | MR. MARK WRIGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 607-431-5979
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NW0100X
-----------------------------------------------------
Taxonomy Name | Women's Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------