Provider Demographics
NPI:1013138080
Name:ELCOR HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ELCOR HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:POES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-739-0304
Mailing Address - Street 1:48 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-8532
Mailing Address - Country:US
Mailing Address - Phone:607-739-0304
Mailing Address - Fax:607-796-0540
Practice Address - Street 1:48 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8532
Practice Address - Country:US
Practice Address - Phone:607-739-0304
Practice Address - Fax:607-796-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0722303N207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY81091AMedicare ID - Type UnspecifiedMCA B - MD SERVICES