Basic Information
| Provider Information | |||||||||
| NPI: | 1689042210 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REGIONAL MEDICAL PRACTICE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 134 HOMER AVE | ||||||||
| Address2: | PO BOX 627 | ||||||||
| City: | CORTLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130451206 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 134 HOMER AVE | ||||||||
| Address2: | |||||||||
| City: | CORTLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130451206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077588019 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2015 | ||||||||
| LastUpdateDate: | 09/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | HIRSCH | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6077588019 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | 3825771 | NY | Y | Hospitals | General Acute Care Hospital | Children |
No ID Information.