Provider Demographics
NPI:1346926441
Name:SOUTHTOWNS ACUPUNCTURE PLLC
Entity Type:Organization
Organization Name:SOUTHTOWNS ACUPUNCTURE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/COMPANY OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RUDNICKI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MS
Authorized Official - Phone:530-412-1213
Mailing Address - Street 1:5441 OLD LAKE SHORE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9751
Mailing Address - Country:US
Mailing Address - Phone:530-412-1213
Mailing Address - Fax:
Practice Address - Street 1:4390 QUINBY DRIVE
Practice Address - Street 2:SUITE F
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-7900
Practice Address - Country:US
Practice Address - Phone:530-412-1213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty