Provider Demographics
NPI:1477959120
Name:INDIAN HEALTH SERVICE LOCKPORT IHS HEALTH CENTER
Entity Type:Organization
Organization Name:INDIAN HEALTH SERVICE LOCKPORT IHS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-280-3853
Mailing Address - Street 1:150 PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5368
Mailing Address - Country:US
Mailing Address - Phone:716-280-3850
Mailing Address - Fax:716-280-3868
Practice Address - Street 1:150 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5368
Practice Address - Country:US
Practice Address - Phone:716-280-3850
Practice Address - Fax:716-280-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare