Provider Demographics
NPI:1821263518
Name:KENTON FAMILY CARE CENTER
Entity Type:Organization
Organization Name:KENTON FAMILY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-447-6100
Mailing Address - Street 1:300 TWO MILE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-6618
Mailing Address - Country:US
Mailing Address - Phone:716-447-6450
Mailing Address - Fax:
Practice Address - Street 1:300 TWO MILE CREEK RD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-6618
Practice Address - Country:US
Practice Address - Phone:716-447-6450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENMORE MERCY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care