Provider Demographics
NPI:1376129015
Name:MEDICAL PRACTITIONER SERVICES OF WNY PC
Entity Type:Organization
Organization Name:MEDICAL PRACTITIONER SERVICES OF WNY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:ARTIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-807-1092
Mailing Address - Street 1:1219 NORTH FOREST ROAD
Mailing Address - Street 2:C/O MEDICAL PRACTITIONER SERVICES OF WNY PC
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2128 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207
Practice Address - Country:US
Practice Address - Phone:716-874-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services