Provider Demographics
NPI:1770678559
Name:FAMILY MEDICINE OF CARTHAGE, PC
Entity Type:Organization
Organization Name:FAMILY MEDICINE OF CARTHAGE, PC
Other - Org Name:FAMILY MEDICINE OF CARTHAGE PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BEANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-493-0128
Mailing Address - Street 1:214 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1212
Mailing Address - Country:US
Mailing Address - Phone:315-493-0128
Mailing Address - Fax:315-493-6200
Practice Address - Street 1:214 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1212
Practice Address - Country:US
Practice Address - Phone:315-493-0128
Practice Address - Fax:315-493-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherFEDERAL TAX ID#