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General NPI Number Information
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NPI Number | 1326185158
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Entity Type | Organization
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Legal Business Name | KEUKA HEALTH CARE ASSOCIATES, P.C.
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 418 N MAIN ST
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City | PENN YAN
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State | NY
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Zip | 14527-1070
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Country | US
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Telephone | 315-536-3308
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Fax | 315-536-0430
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Provider Business Mailing Address
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Address Line | 418 N MAIN ST
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City | PENN YAN
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State | NY
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Zip | 14527-1070
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Country | US
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Telephone | 315-536-3308
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Fax | 315-536-0430
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM P. WELBOURNE
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Credential | M.D.
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Telephone | 315-536-3308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 119889
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F331889
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License Number State | NY
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