Provider Demographics
NPI:1811080963
Name:EPC, LLC
Entity type:Organization
Organization Name:EPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RN MBA CASC
Authorized Official - Phone:315-488-2538
Mailing Address - Street 1:260 TOWNSHIP BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1677
Mailing Address - Country:US
Mailing Address - Phone:315-488-3905
Mailing Address - Fax:315-488-2301
Practice Address - Street 1:260 TOWNSHIP BLVD STE 10
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1677
Practice Address - Country:US
Practice Address - Phone:315-488-3905
Practice Address - Fax:315-488-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3301220R261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02772287Medicaid
NYY48183Medicare UPIN
NY02772287Medicaid