Provider Demographics
NPI:1093160012
Name:UPSTATE FAMILY HEALTH CENTER INCORPORATED
Entity type:Organization
Organization Name:UPSTATE FAMILY HEALTH CENTER INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-624-9470
Mailing Address - Street 1:205 W DOMINICK ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-5811
Mailing Address - Country:US
Mailing Address - Phone:315-507-2081
Mailing Address - Fax:315-507-2847
Practice Address - Street 1:1001 NOYES ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4400
Practice Address - Country:US
Practice Address - Phone:315-624-9470
Practice Address - Fax:315-624-9480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center