Faxton St Lukes Healthcare

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

3203003H Issued in NY

Legal business name

FAXTON ST LUKES HEALTHCARE

Practice address

1650 Champlin Ave
Utica, NY 13502

Phone

(315) 624-5145

Fax

(315) 624-6113

NPI assigned

Apr 11, 2013

Organization subpart

Yes

Parent organization

FAXTON ST LUKES HEALTHCAREAs reported in NPPES

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

Authorized official

Name

Cody White

Title

Executive Director

Phone

(315) 801-4429

Specialties & licenses 1

Addresses

Electronic endpoints 1

Part of

MVHS Inc

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

{
    "created_epoch": "1365638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1154764934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2209 GENESEE ST/ BUSINESS OFFICE",
            "address_2": "ROOM #315",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135015809",
            "telephone_number": "315-018-3282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 CHAMPLIN AVE",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "13502",
            "telephone_number": "315-624-5145",
            "fax_number": "315-624-6113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAXTON ST LUKES HEALTHCARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAXTON ST LUKES HEALTHCARE",
        "enumeration_date": "2013-04-11",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "CODY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "315-801-4429"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NY",
            "license": "3203003H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mike Joseph Fanelli, DDS
• Sandra L Farnell, LMHC
• Elizabeth A Farnum, MD
• Verne Franklin Faulkner
• Faxton St Lukes Healthcare
• Faxton St Lukes Healthcare
• Faxton St. Luke'S Healthcare
• Faxton-St. Lukes Healthcare
• Faxton-Sunset St. Luke'S Health Care Center Inc
• Fayez F. Chahfe, M.D.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Utica, NY
• Providers in Utica, NY by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; 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.