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General NPI Number Information
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NPI Number | 1356656045
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Entity Type | Organization
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Legal Business Name | ADIRONDACK MEDICAL CENTER
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 10/16/2014
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Provider Practice Location Address
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Address Line | 114 WAWBEEK AVE
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City | TUPPER LAKE
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State | NY
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Zip | 12986-2038
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Country | US
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Telephone | 518-359-4900
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Fax | 518-891-5097
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Provider Business Mailing Address
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Address Line | 114 WAWBEEK AVE
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City | TUPPER LAKE
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State | NY
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Zip | 12986-2038
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Country | US
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Telephone | 518-359-4900
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Fax | 518-891-5097
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Authorized Official
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Title or Position | PFS SUPERVISOR
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Name | SUSAN S STRATFORD
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Credential | CPC
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Telephone | 518-897-2636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 1623001H
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License Number State | NY
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