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General NPI Number Information
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NPI Number | 1184883555
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Entity Type | Organization
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Legal Business Name | NORTH COUNTRY FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 428 WASHINGTON ST STE 4
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City | WATERTOWN
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State | NY
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Zip | 13601-4832
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Country | US
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Telephone | 315-788-4880
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Fax | 315-788-4896
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Provider Business Mailing Address
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Address Line | 445 FACTORY ST PO BOX 91
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City | WATERTOWN
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State | NY
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Zip | 13601-2729
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Country | US
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Telephone | 315-782-4207
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Fax | 315-782-8699
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | JON A EMERTON
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Credential | M.D.
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Telephone | 315-788-4880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 227318
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License Number State | NY
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