| Hudson Headwaters Health Network | |
|
1019 Wicker St Ticonderoga NY 12883-1039 | |
| (518) 745-5936 | |
| Not Available |
| Full Name | Hudson Headwaters Health Network |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1019 Wicker St, Ticonderoga, New York |
| Authorized Official Name and Position | Christopher Tournier (CFO) |
| Authorized Official Contact | 5187610300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hudson Headwaters Health Network 9 Carey Rd Queensbury NY 12804-7880 Ph: (518) 761-0300 | Hudson Headwaters Health Network 1019 Wicker St Ticonderoga NY 12883-1039 Ph: (518) 745-5936 |
| NPI Number | 1699056291 |
|---|---|
| Provider Enumeration Date | 09/09/2011 |
| Last Update Date | 11/16/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699056291 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 5660200R (New York) | Primary |
Hudson Headwaters Health Network Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1019 Wicker St, Ticonderoga, NY 12883 Phone: 518-761-0300 Fax: 518-824-2318 |