Provider Demographics
NPI:1629634985
Name:SOUTHERN TIER WOMEN'S HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:SOUTHERN TIER WOMEN'S HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:COUSINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-785-4171
Mailing Address - Street 1:PO BOX 642
Mailing Address - Street 2:149 VESTAL PARKWAY WEST
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13851-0642
Mailing Address - Country:US
Mailing Address - Phone:607-785-4171
Mailing Address - Fax:607-785-3915
Practice Address - Street 1:149 VESTAL PARKWAY WEST
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850
Practice Address - Country:US
Practice Address - Phone:607-785-4171
Practice Address - Fax:607-785-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty