Provider Demographics
NPI:1114979945
Name:CLINTON COUNTY
Entity Type:Organization
Organization Name:CLINTON COUNTY
Other - Org Name:CLINTON COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH FACILITY COMPTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUBUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-565-3284
Mailing Address - Street 1:133 MARGARET ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2926
Mailing Address - Country:US
Mailing Address - Phone:518-565-4840
Mailing Address - Fax:518-565-4717
Practice Address - Street 1:133 MARGARET STREET
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-565-4840
Practice Address - Fax:518-565-4717
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINTON COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09012008261Q00000X
NY0901200R261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00583757Medicaid
54686BMedicare Oscar/Certification