=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689689325
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UPSTATE COMMUNICATION RESOURCE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 GROVE ST SUITE #115
-----------------------------------------------------
City | PITTSFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14534-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-264-0527
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 GROVE ST SUITE #115
-----------------------------------------------------
City | PITTSFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14534-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-264-0527
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. NANCY MILLET
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 585-264-0527
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------