NPIMap

Organization Active NPI

Hudson Headwaters Health Network

  • Physician Assistant
  • Indian Lake, NY
National Provider Identifier
1154343168
Registry record updated Sep 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
6846 Issued in NY
Legal business name
HUDSON HEADWATERS HEALTH NETWORK
Practice address
Main Street and Pelon Road
Indian Lake, NY 12842-0684
Phone
(518) 648-5707
Fax
(518) 648-6160
NPI assigned
Jul 25, 2006
Organization subpart
Yes
Parent organization
HUDSON HEADWATERS HEALTH NETWORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 17, 2010

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

Authorized official

Name
Christopher Tournier
Title
Chief Financial Officer
Phone
(518) 761-0300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X 6846 NY Primary

Addresses

Primary practice location

Main Street and Pelon Road
Indian Lake, NY 12842-0684

Mailing address

9 Carey Rd
Queensbury, NY 12804-7880
Phone (518) 761-0300

National Provider Directory

National Provider Directory
Tax ID family
Hudson Headwaters HLTH43 organizations share this tax ID, including this one
Part of
Hudson Headwaters HLTH

Other organizations with this tax ID 42

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

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284681600000",
    "number": "1154343168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047880",
            "telephone_number": "518-761-0300",
            "fax_number": "518-480-0108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MAIN STREET AND PELON ROAD",
            "city": "INDIAN LAKE",
            "state": "NY",
            "postal_code": "128420684",
            "telephone_number": "518-648-5707",
            "fax_number": "518-648-6160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUDSON HEADWATERS HEALTH NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HUDSON HEADWATERS HEALTH NETWORK",
        "enumeration_date": "2006-07-25",
        "last_updated": "2010-09-17",
        "status": "A",
        "authorized_official_last_name": "TOURNIER",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "518-761-0300"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "6846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indian Lake, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2010; 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.