Provider Demographics
NPI:1780633982
Name:FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC.
Other - Org Name:FAMILY HEALTH NETWORK MOBILE VAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-753-3797
Mailing Address - Street 1:85 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1542
Mailing Address - Country:US
Mailing Address - Phone:607-753-3797
Mailing Address - Fax:607-753-6677
Practice Address - Street 1:85 S WEST ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077-1542
Practice Address - Country:US
Practice Address - Phone:607-753-3797
Practice Address - Fax:607-753-6677
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-08
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X
NY261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00474144Medicaid
NYQ00772Medicare UPIN
NYS36235Medicare UPIN
NYS10117Medicare UPIN
NYS58346Medicare UPIN
NYB82599Medicare UPIN
NYH64076Medicare UPIN
NYP16554Medicare UPIN
NYP26744Medicare UPIN
NYS80377Medicare UPIN
NYG44914Medicare UPIN
NYI35959Medicare UPIN
NYP61943Medicare UPIN
NYP80013Medicare UPIN
NYE41529Medicare UPIN
NYP37436Medicare UPIN