MEDICARE: JEFFERSON COUNTY PUBLIC HEALTH SERVICE

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	261QP0905X	State or Local Public Health Clinic/Center	2201200R	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	54558B	OTHER	NY	MEDICARE PART B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2201200R	OTHER	NY	OPERATING CERTIFICATE

General Provider Information

NPI Number	:	1558427849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON COUNTY PUBLIC HEALTH SERVICE

Provider Business Mailing Address
First Line	:	531 MEADE ST
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-1225
Country	:	US
Telephone Number	:	315-786-3710
Fax Number	:	315-786-3761

Provider Business Practice Location Address
First Line	:	531 MEADE ST
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-1225
Country	:	US
Telephone Number	:	315-786-3710
Fax Number	:	315-786-3761

Authorized Official
Title or Position	:	PUBLIC HEALTH DIRECTOR
Name	:	MR. STEPHEN A. JENNINGS
Credential	:
Telephone Number	:	315-786-3715

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	08/08/2025

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Directions to “JEFFERSON COUNTY PUBLIC HEALTH SERVICE ” Practice Location

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