Provider Demographics
NPI:1396492369
Name:SOUTHERN TIER FAMILY NURSE PRACTITIONER SERVICES
Entity type:Organization
Organization Name:SOUTHERN TIER FAMILY NURSE PRACTITIONER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:607-677-0011
Mailing Address - Street 1:520 COLUMBIA DR STE 203
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-3305
Mailing Address - Country:US
Mailing Address - Phone:607-677-0011
Mailing Address - Fax:
Practice Address - Street 1:520 COLUMBIA DR STE 203
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-3305
Practice Address - Country:US
Practice Address - Phone:607-677-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty