Provider Demographics
NPI: | 1356378889 |
---|---|
Name: | CHEMUNG MEDICAL SERVICES PC |
Entity type: | Organization |
Organization Name: | CHEMUNG MEDICAL SERVICES PC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | KEVIN |
Authorized Official - Last Name: | LAMBERT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 607-271-2050 |
Mailing Address - Street 1: | 722 W WATER ST |
Mailing Address - Street 2: | |
Mailing Address - City: | ELMIRA |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 14905-2435 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 607-271-2050 |
Mailing Address - Fax: | 607-271-2099 |
Practice Address - Street 1: | 600 IVY ST |
Practice Address - Street 2: | |
Practice Address - City: | ELMIRA |
Practice Address - State: | NY |
Practice Address - Zip Code: | 14905-1627 |
Practice Address - Country: | US |
Practice Address - Phone: | 607-737-4500 |
Practice Address - Fax: | 607-737-7700 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-06-28 |
Last Update Date: | 2014-06-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 2083X0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | Group - Multi-Specialty |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 00372050 | Medicaid | |
PA | 000642916 | Medicaid | |
CC2319 | Medicare ID - Type Unspecified | RR MEDICARE GROUP # | |
PA | 022827 | Medicare ID - Type Unspecified | GROUP ID # |
PA | 000642916 | Medicaid |