Provider Demographics
NPI:1942621800
Name:MIDDLETOWN COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:MIDDLETOWN COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARYJO
Authorized Official - Middle Name:
Authorized Official - Last Name:JOBITY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-343-7614
Mailing Address - Street 1:21 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 BROTHERHOOD PLAZA DR
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-2260
Practice Address - Country:US
Practice Address - Phone:845-614-5981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355931Medicaid
331897Medicare Oscar/Certification