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General NPI Number Information
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NPI Number | 1811434103
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Entity Type | Organization
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Legal Business Name | BETHANY VILLAGE PRIMARY CARE NETWORK, INC.
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 2977 WESTINGHOUSE RD
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City | HORSEHEADS
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State | NY
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Zip | 14845-8120
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Country | US
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Telephone | 607-378-6662
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Fax | 607-378-6668
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Provider Business Mailing Address
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Address Line | 2977 WESTINGHOUSE RD
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City | HORSEHEADS
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State | NY
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Zip | 14845-8120
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Country | US
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Telephone | 607-378-6662
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Fax | 607-378-6668
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. MICHAEL KISER
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Credential | CPA
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Telephone | 607-378-6574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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