=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649555079
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXAMINATION MANAGEMENT SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2011
-----------------------------------------------------
Last Update Date | 10/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1874 MECKLENBURG RD
-----------------------------------------------------
City | ITHACA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14850-9238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-273-0369
-----------------------------------------------------
Fax | 607-273-0369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1874 MECKLENBURG RD
-----------------------------------------------------
City | ITHACA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14850-9238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-273-0369
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | CARRIE LYNN GOODRICH
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 607-857-6670
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | 336951
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------