NPIMap

Organization Active NPI

KPH Healthcare Services, Inc.

Doing business as Kinney Drugs #08

  • Community/Retail Pharmacy
  • Watertown, NY
National Provider Identifier
1245347939
Registry record updated Apr 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
KPH HEALTHCARE SERVICES, INC.
Doing business as
Kinney Drugs #08
Practice address
22056 US Route 11
Watertown, NY 13601-1693
Phone
(315) 782-6530
Fax
(315) 786-0870
NPI assigned
Aug 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2014

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

Authorized official

Name
Lisa L Weir
Title
Third Party Administrator
Phone
(315) 287-3600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 013569 NY
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

22056 US Route 11
Watertown, NY 13601-1693

Mailing address

29 E Main St
Gouverneur, NY 13642-1401
Phone (315) 287-3600

Other identifiers 2

IdentifierTypeStateIssuer
3347728OtherOTHER ID NUMBER-COMMERCIAL NUMBER
00561977MedicaidNY

Other names 1

  • Kinney Drugs #08 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110921000274 NY Part B Supplier - Mass Immunization (Roster Biller Only) 9830217637 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396569600000",
    "number": "1245347939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 E MAIN ST",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "136421401",
            "telephone_number": "315-287-3600",
            "fax_number": "315-287-4291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22056 US ROUTE 11",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136011693",
            "telephone_number": "315-782-6530",
            "fax_number": "315-786-0870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KPH HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2014-04-04",
        "status": "A",
        "authorized_official_last_name": "WEIR",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "THIRD PARTY ADMINISTRATOR",
        "authorized_official_telephone_number": "315-287-3600"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "013569",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3347728",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00561977",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kinney Drugs #08",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watertown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.