Provider Demographics
NPI:1376647602
Name:COLUMBIA COUNTY
Entity Type:Organization
Organization Name:COLUMBIA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-672-7408
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:PHILMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12565-0785
Mailing Address - Country:US
Mailing Address - Phone:518-672-7408
Mailing Address - Fax:518-672-4721
Practice Address - Street 1:201 MAIN STREET RTE 217
Practice Address - Street 2:
Practice Address - City:PHILMONT
Practice Address - State:NY
Practice Address - Zip Code:12565-0785
Practice Address - Country:US
Practice Address - Phone:518-672-7408
Practice Address - Fax:518-672-4721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1021300N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY714144FOtherMVP PROVIDER NUMBER
NY00473345Medicaid
NY10031340OtherCDPHP PROVIDER NUMBER
NY00400261003OtherBLUE SHIELD PROVIDER NUMB
NY714144FOtherMVP PROVIDER NUMBER