| Hudson Headwaters Health Network | |
|
828 State Route 11 Champlain NY 12919-4966 | |
| (518) 298-2691 | |
| (518) 298-8241 |
| Full Name | Hudson Headwaters Health Network |
|---|---|
| Speciality | Clinic/Center |
| Location | 828 State Route 11, Champlain, New York |
| Authorized Official Name and Position | Laura Pasco (EXECUTIVE VP, CFO) |
| Authorized Official Contact | 5187610300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hudson Headwaters Health Network 9 Carey Rd Queensbury NY 12804-7880 Ph: (518) 761-0300 | Hudson Headwaters Health Network 828 State Route 11 Champlain NY 12919-4966 Ph: (518) 298-2691 |
| NPI Number | 1245285170 |
|---|---|
| Provider Enumeration Date | 05/22/2006 |
| Last Update Date | 02/23/2024 |
| Medicare PECOS PAC ID | 7416861208 |
|---|---|
| Medicare Enrollment ID | O20121228000031 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245285170 | NPI | - | NPPES |
| 02384669 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (New York) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |