Provider Demographics
NPI:1891195095
Name:NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.
Other - Org Name:FULTON HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:SR. VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:WIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-298-6569
Mailing Address - Street 1:510 S 4TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-2904
Mailing Address - Country:US
Mailing Address - Phone:315-598-4790
Mailing Address - Fax:315-593-6195
Practice Address - Street 1:510 S 4TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2904
Practice Address - Country:US
Practice Address - Phone:315-598-4790
Practice Address - Fax:315-593-6195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-26
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health