MEDICARE: GUTHRIE AHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center

General Provider Information

NPI Number	:	1164637112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUTHRIE AHC

Provider Business Mailing Address
First Line	:	11050 MOUNT BELVEDERE BLVD
Second Line	:	UBO
City	:	FORT DRUM
State	:	NY
Zip	:	13602-5438
Country	:	US
Telephone Number	:	315-772-4033
Fax Number	:

Provider Business Practice Location Address
First Line	:	10205 N RIVA RIDGE LOOP
Second Line	:	SUITE P36
City	:	FORT DRUM
State	:	NY
Zip	:	13602-5457
Country	:	US
Telephone Number	:	315-772-2778
Fax Number	:

Authorized Official
Title or Position	:	ACTING UBO MANAGER
Name	:	NANCY DRAPER
Credential	:
Telephone Number	:	315-772-1755

Provider Enumeration Date	:	05/13/2007
Last Update Date	:	03/23/2015

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Directions to “GUTHRIE AHC ” Practice Location

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