Provider Demographics
NPI:1760747521
Name:THE CHAUTAUQUA CENTER, INC
Entity Type:Organization
Organization Name:THE CHAUTAUQUA CENTER, INC
Other - Org Name:CHAUTAUQUA CENTER, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:PEASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-363-6050
Mailing Address - Street 1:75 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048
Mailing Address - Country:US
Mailing Address - Phone:716-363-6050
Mailing Address - Fax:716-363-6333
Practice Address - Street 1:75 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048
Practice Address - Country:US
Practice Address - Phone:716-363-6050
Practice Address - Fax:716-363-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0376030Medicaid