Provider Demographics
NPI:1417213158
Name:AURELIA OSBORN FOX MEMORIAL HOSPITAL SOHC
Entity Type:Organization
Organization Name:AURELIA OSBORN FOX MEMORIAL HOSPITAL SOHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-431-5305
Mailing Address - Street 1:1 NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2629
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 DECATUR STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:NY
Practice Address - Zip Code:12197
Practice Address - Country:US
Practice Address - Phone:607-397-8783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AURELIA OSBORN FOX MEMORIAL HOSPITAL SOHC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty