Provider Demographics
NPI:1053469346
Name:COUNTY OF STEUBEN
Entity Type:Organization
Organization Name:COUNTY OF STEUBEN
Other - Org Name:STEUBEN COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:R
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-664-2438
Mailing Address - Street 1:3 PULTENEY SQ E
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1510
Mailing Address - Country:US
Mailing Address - Phone:607-664-2438
Mailing Address - Fax:607-664-2166
Practice Address - Street 1:3 PULTENEY SQ E
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1510
Practice Address - Country:US
Practice Address - Phone:607-664-2438
Practice Address - Fax:607-664-2166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF STEUBEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-05
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5022200261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355404Medicaid