Provider Demographics
NPI:1760562722
Name:MADISON COUNTY
Entity Type:Organization
Organization Name:MADISON COUNTY
Other - Org Name:MADISON COUNTY HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:FAISST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-366-2501
Mailing Address - Street 1:PO BOX 605
Mailing Address - Street 2:
Mailing Address - City:WAMPSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13163-0605
Mailing Address - Country:US
Mailing Address - Phone:315-366-2501
Mailing Address - Fax:315-366-2207
Practice Address - Street 1:BUILDING 5 NORTH COURT STREET
Practice Address - Street 2:
Practice Address - City:WAMPSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13163-0605
Practice Address - Country:US
Practice Address - Phone:315-366-2501
Practice Address - Fax:315-366-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00474259Medicaid
NY337119Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER