MEDICARE: FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC

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	261QF0400X	Federally Qualified Health Center (FQHC)

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	331837	OTHER	NY	MEDICARE PTAN

General Provider Information

NPI Number	:	1659654101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC

Provider Business Mailing Address
First Line	:	85 SOUTH WEST STREET
Second Line	:
City	:	HOMER
State	:	NY
Zip	:	13077-0000
Country	:	US
Telephone Number	:	607-753-3797
Fax Number	:	607-753-6677

Provider Business Practice Location Address
First Line	:	2805 CINCINNATUS ROAD
Second Line	:
City	:	CINCINNATUS
State	:	NY
Zip	:	13040-0199
Country	:	US
Telephone Number	:	607-863-4126
Fax Number	:	607-863-3455

Authorized Official
Title or Position	:	CEO
Name	:	MR. KIMBERLY OSBORNE
Credential	:
Telephone Number	:	607-753-3797

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	01/12/2022

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