Provider Demographics
NPI:1710052451
Name:NORTH COUNTRY ADULT MEDICINE PLLC
Entity Type:Organization
Organization Name:NORTH COUNTRY ADULT MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-764-1121
Mailing Address - Street 1:38 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1018
Mailing Address - Country:US
Mailing Address - Phone:315-764-1121
Mailing Address - Fax:315-764-1972
Practice Address - Street 1:38 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1018
Practice Address - Country:US
Practice Address - Phone:315-764-1121
Practice Address - Fax:315-764-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02883067Medicaid
NYAA1721Medicare PIN