Provider Demographics
NPI:1609541051
Name:THEPHWC LLP
Entity Type:Organization
Organization Name:THEPHWC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNTUNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-578-4749
Mailing Address - Street 1:334 CORNELIA ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2329
Mailing Address - Country:US
Mailing Address - Phone:518-578-4749
Mailing Address - Fax:
Practice Address - Street 1:1942 MILITARY TPKE
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-7375
Practice Address - Country:US
Practice Address - Phone:518-310-3644
Practice Address - Fax:518-310-3645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty