Provider Demographics
NPI:1265450795
Name:ELIZABETH ANN BLEDSOE NURSE PRACTITIONER IN ADULT HEALTH
Entity Type:Organization
Organization Name:ELIZABETH ANN BLEDSOE NURSE PRACTITIONER IN ADULT HEALTH
Other - Org Name:HILLSDALE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BLEDSOE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:518-325-2273
Mailing Address - Street 1:2818 STATE ROUTE 23
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12529-5941
Mailing Address - Country:US
Mailing Address - Phone:518-325-2273
Mailing Address - Fax:518-325-2275
Practice Address - Street 1:2818 STATE ROUTE 23
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NY
Practice Address - Zip Code:12529-5941
Practice Address - Country:US
Practice Address - Phone:518-325-2273
Practice Address - Fax:518-325-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304325-1261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ67908Medicare UPIN
NYWHW671Medicare PIN