NPIMap

Organization Active NPI

Keith a Nichols MD, PLLC

  • Family Medicine Physician
  • Owego, NY
National Provider Identifier
1346421211
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
141416-1 Issued in NY
Legal business name
KEITH A NICHOLS MD, PLLC
Practice address
130 Temple St
Suite 100
Owego, NY 13827-1408
Phone
(607) 687-5616
NPI assigned
Nov 20, 2007
Last updated
Nov 20, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

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

Authorized official

Name
Jane E Nichols
Title
Business Manager
Phone
(607) 687-5616

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 141416-1 NY Primary

Addresses

Primary practice location

130 Temple St
Suite 100
Owego, NY 13827-1408

Mailing address

130 Temple St
Suite 100
Owego, NY 13827-1408
Phone (607) 687-5616

Other identifiers 1

IdentifierTypeStateIssuer
00709866MedicaidNY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1195516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195516800000",
    "number": "1346421211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 TEMPLE ST",
            "address_2": "SUITE 100",
            "city": "OWEGO",
            "state": "NY",
            "postal_code": "138271408",
            "telephone_number": "607-687-5616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 TEMPLE ST",
            "address_2": "SUITE 100",
            "city": "OWEGO",
            "state": "NY",
            "postal_code": "138271408",
            "telephone_number": "607-687-5616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH A NICHOLS MD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-20",
        "last_updated": "2007-11-20",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "JANE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "607-687-5616"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "141416-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00709866",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Owego, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; 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.