Provider Demographics
NPI:1023049830
Name:QC-MEDI NEW YORK, INC.
Entity type:Organization
Organization Name:QC-MEDI NEW YORK, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-899-1158
Mailing Address - Street 1:6330 SPRINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 USHERS RD
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1515
Practice Address - Country:US
Practice Address - Phone:518-899-1158
Practice Address - Fax:518-899-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01573711Medicaid
337401OtherG2
020014OtherG2
112256479OtherG2
335394OtherG2
1166983OtherG2
120243OtherG2
502111OtherG2
00051303001OtherG2
000161506OtherG2
337224OtherG2
116529OtherG2
34511OtherG2
7215344OtherG2
00013277202OtherG2
801438OtherG2
000051300170OtherG2
10002879OtherG2
18618OtherG2
337224OtherG2