Provider Demographics
NPI:1689724262
Name:ORLEANS MEDICAL PC
Entity Type:Organization
Organization Name:ORLEANS MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KLOTZBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, NP
Authorized Official - Phone:585-798-1053
Mailing Address - Street 1:11075 W CENTER STREET EXT
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-9557
Mailing Address - Country:US
Mailing Address - Phone:585-798-1053
Mailing Address - Fax:585-798-5639
Practice Address - Street 1:11075 W CENTER STREET EXT
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-9557
Practice Address - Country:US
Practice Address - Phone:585-798-1053
Practice Address - Fax:585-798-5639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00642420Medicaid
NY02081836Medicaid
NY082545Medicare ID - Type Unspecified
B73667Medicare UPIN
NY02081836Medicaid