Basic Information
| Provider Information | |||||||||
| NPI: | 1376596304 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TWIN COUNTY MEDICAL ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 67 PROSPECT AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125342907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188282566 | ||||||||
| FaxNumber: | 5188284055 | ||||||||
| Practice Location | |||||||||
| Address1: | 67 PROSPECT AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125342907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188282566 | ||||||||
| FaxNumber: | 5188284055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 05/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | CLINTON | ||||||||
| AuthorizedOfficialFirstName: | H LOUIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5188282566 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RP1001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RN0300X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207UN0901X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200051080 | 01 | MVP | OTHER | 993718 | 01 | UNITED | OTHER | 1240 | 01 | NY | CDPHP | OTHER | GRP400112005 | 01 | NY | BS OF NENY | OTHER |