Family Medicine Associates of Ithaca

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

143456 Issued in NY

Legal business name

FAMILY MEDICINE ASSOCIATES OF ITHACA

Practice address

209 W State St
Ithaca, NY 14850-5429

Phone

(607) 277-4341

NPI assigned

Jul 18, 2014

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenny Heine

Title

VP of Operations

Phone

(858) 964-1506

Specialties & licenses 1

Addresses

Other names 1

• Family Medicine Associates State St Doing business as

Tax ID family

Family Medicine Associates of Ithaca2 organizations share this tax ID, including this one

Part of

Tri - State Medical Group Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Family Medicine Associates of Ithaca

  • Non-Pharmacy Dispensing Site
  • Ithaca, NY
  • NPI 1376950352
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405900800000",
    "number": "1013324318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 W STATE ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148505429",
            "telephone_number": "607-277-4341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE ASSOCIATES OF ITHACA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2014-07-18",
        "last_updated": "2014-07-21",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NY",
            "license": "143456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine Associates State St",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lorraine Faehndrich
• Fall Creek Family Dentist
• Fall Creek Health Care
• Family & Children'S Service of Ithaca Inc
• Family and Children Services of Ithaca
• Family Medicine Associates of Ithaca
• Family Medicine Associates of Ithaca LLP
• Diane Russell Farnham, P.T.
• Megan L. Farrell, RN
• Misty Melissa Fearon, PT

• Non-Pharmacy Dispensing Site in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Non-Pharmacy Dispensing Site in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.