Provider Demographics
NPI:1922368182
Name:MONROE COUNTY HEALTH DEPT CLINICS
Entity Type:Organization
Organization Name:MONROE COUNTY HEALTH DEPT CLINICS
Other - Org Name:MC STD PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:PATIENT ACCOUNTING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CIVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOCHREITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-753-6664
Mailing Address - Street 1:111 WESTFALL RD
Mailing Address - Street 2:RM 342
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4647
Mailing Address - Country:US
Mailing Address - Phone:585-753-6664
Mailing Address - Fax:585-753-6903
Practice Address - Street 1:855 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-2335
Practice Address - Country:US
Practice Address - Phone:585-753-6664
Practice Address - Fax:585-753-6903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONROE COUNTY HEALTH DEPT CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-22
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355293Medicaid