Provider Demographics
NPI:1598073777
Name:MOSAIC HEALTH, INC.
Entity Type:Organization
Organization Name:MOSAIC HEALTH, INC.
Other - Org Name:ROCHESTER PRIMARY CARE NETWORK, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSCAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-703-9234
Mailing Address - Street 1:1 S WASHINGTON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14614-1134
Mailing Address - Country:US
Mailing Address - Phone:585-325-2280
Mailing Address - Fax:585-325-2293
Practice Address - Street 1:1 MURRAY HILL DR
Practice Address - Street 2:BUILDING #1, ROOM 140
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-1153
Practice Address - Country:US
Practice Address - Phone:585-243-7840
Practice Address - Fax:585-335-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X
NY1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00618199Medicaid