Basic Information
Provider Information | |||||||||
NPI: | 1225394943 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | AURELIA OSBORN FOX MEMORIAL HOSPITAL FOX INTERNAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 NORTON AVE | ||||||||
Address2: |   | ||||||||
City: | ONEONTA | ||||||||
State: | NY | ||||||||
PostalCode: | 138202629 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6074322000 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1 FOXCARE DR | ||||||||
Address2: | SUITE # 302 | ||||||||
City: | ONEONTA | ||||||||
State: | NY | ||||||||
PostalCode: | 138202099 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6074315290 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/06/2012 | ||||||||
LastUpdateDate: | 04/11/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SMITH | ||||||||
AuthorizedOfficialFirstName: | TRACEY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | STAFF ACCOUNTANT | ||||||||
AuthorizedOfficialTelephone: | 6074312000 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | AURELIA OSBORN FOX MEMORIAL HOSPITAL | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 225598 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.