Provider Demographics
NPI:1508119884
Name:ORLEANS COMMUNITY HEALTH
Entity Type:Organization
Organization Name:ORLEANS COMMUNITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-798-8422
Mailing Address - Street 1:200 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-1063
Mailing Address - Country:US
Mailing Address - Phone:585-798-8422
Mailing Address - Fax:585-798-8444
Practice Address - Street 1:14789 RT 31
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411
Practice Address - Country:US
Practice Address - Phone:585-589-2273
Practice Address - Fax:585-589-1876
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORLEANS COMMUNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-24
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3622700OtherLICENSE
NY333975OtherMEDICARE PTAN