Provider Demographics
NPI:1265798169
Name:SOUTHERN TIER PRIORITY HEALTHCARE
Entity type:Organization
Organization Name:SOUTHERN TIER PRIORITY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REEDA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-795-5215
Mailing Address - Street 1:130 LATTABROOK RD
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-8501
Mailing Address - Country:US
Mailing Address - Phone:607-795-5215
Mailing Address - Fax:607-795-5219
Practice Address - Street 1:130 LATTABROOK RD
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8501
Practice Address - Country:US
Practice Address - Phone:607-795-5215
Practice Address - Fax:607-795-5219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01381319Medicaid