Provider Demographics
NPI:1598711988
Name:COUNTY OF CATTARAUGUS
Entity Type:Organization
Organization Name:COUNTY OF CATTARAUGUS
Other - Org Name:LABORATORY
Other - Org Type:Other Name
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:716-701-3398
Mailing Address - Street 1:1 LEO MOSS DR
Mailing Address - Street 2:SUITE 4010
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1100
Mailing Address - Country:US
Mailing Address - Phone:716-373-8050
Mailing Address - Fax:716-701-3737
Practice Address - Street 1:1 LEO MOSS DR
Practice Address - Street 2:SUITE 4010
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1100
Practice Address - Country:US
Practice Address - Phone:716-701-3398
Practice Address - Fax:716-701-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D0654979, PFI 1935291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0005047841001OtherBC/BS
NY00635685Medicaid
NY0005047841001OtherBC/BS
NY00635685Medicaid