MEDICARE: KPH HEALTHCARE SERVICES, 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	333600000X	Pharmacy	026934	NY
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3340255	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1992812176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KPH HEALTHCARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	29 E MAIN ST
Second Line	:
City	:	GOUVERNEUR
State	:	NY
Zip	:	13642-1401
Country	:	US
Telephone Number	:	315-287-3600
Fax Number	:	315-287-4291

Provider Business Practice Location Address
First Line	:	596 ROUTE 11
Second Line	:
City	:	TULLY
State	:	NY
Zip	:	13159
Country	:	US
Telephone Number	:	315-696-8796
Fax Number	:	315-696-6145

Authorized Official
Title or Position	:	THIRD PARTY ADMINISTRATOR
Name	:	ELIZABETH M MARLOW
Credential	:
Telephone Number	:	315-287-3600

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/04/2024

Similar Medicare Providers

1386686376 — DR. JERRY RUSSELL BARTLESON M.D.
Practice Location Address:

7434 SONG LAKE RD
TULLY, NY
13159-9211

Practice Phone: 315-569-6329
Practice Fax: 315-696-5539

1134925928 — MORGAN HILTBRAND
Practice Location Address:

954 STATE ROUTE 11A
TULLY, NY
13159-2426

Practice Phone: 315-741-0945
Practice Fax:

1427037159 — DR. AHMAD M MEHDI MD
Practice Location Address:

505 STATE ROUTE 281
TULLY, NY
13159-2547

Practice Phone: 315-696-7304
Practice Fax: 315-696-5251

1457339756 — JAMES E EDINGER MD
Practice Location Address:

57 STATE ST
TULLY, NY
13159-3218

Practice Phone: 315-696-4635
Practice Fax: 315-696-6108

1588607352 — TOWN OF TULLY
Practice Location Address:

1 RAILROAD ST
TULLY, NY
13159-3245

Practice Phone: 315-696-6414
Practice Fax: 315-696-8396

1386752442 — MRS. CHERYL K KARPINSKI LCSWR
Practice Location Address:

426 LONG RD
TULLY, NY
13159-9430

Practice Phone: 315-727-8855
Practice Fax: 315-696-8251

Directions to “KPH HEALTHCARE SERVICES, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.