Provider Demographics
NPI:1568006112
Name:ONEONTA FAMILY MEDICINE CLINIC
Entity Type:Organization
Organization Name:ONEONTA FAMILY MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-779-8698
Mailing Address - Street 1:1123 COUNTY HIGHWAY 26
Mailing Address - Street 2:
Mailing Address - City:FLY CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:13337-2703
Mailing Address - Country:US
Mailing Address - Phone:607-779-8698
Mailing Address - Fax:
Practice Address - Street 1:1123 COUNTY HIGHWAY 26
Practice Address - Street 2:
Practice Address - City:FLY CREEK
Practice Address - State:NY
Practice Address - Zip Code:13337-2703
Practice Address - Country:US
Practice Address - Phone:607-779-8698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty