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)

General Provider Information

NPI Number	:	1780633982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC.

Provider Business Mailing Address
First Line	:	85 S WEST ST
Second Line	:
City	:	HOMER
State	:	NY
Zip	:	13077-1542
Country	:	US
Telephone Number	:	607-753-3797
Fax Number	:	607-753-6677

Provider Business Practice Location Address
First Line	:	85 S WEST ST
Second Line	:
City	:	HOMER
State	:	NY
Zip	:	13077-1542
Country	:	US
Telephone Number	:	607-753-3797
Fax Number	:	607-753-6677

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	10/21/2022

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