KPH Healthcare Services, Inc.
Organization
Active NPI
Community/Retail Pharmacy · Chittenango, NY
NPI 1831206010 · NPPES record last updated Jul 4, 2024
Key facts
- NPI
- 1831206010
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- KPH HEALTHCARE SERVICES, INC.
- Practice address
- 540 Genesee St.
Chittenango, NY 13037
- Phone
- (315) 687-6110
- Fax
- (315) 687-1046
- NPI assigned
- Aug 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Elizabeth M Marlow
- Title
- Third Party Administrator
- Phone
- (315) 287-3600
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
Laboratory certificates & supplier records
Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|
| 33D2122957 | Kinney Drugs 46
540 E Genesee Street, Chittenango, NY 13037 | Certificate of waiver | Mar 26, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|
KPH Healthcare Services Inc
540 Genesee St, Chittenango, NY 13037-1606 · (315) 687-6110 |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|(TENS) Transcutaneous Electrical Nerve Stimulators and/or Supplies|Canes and/or Crutches|Wa… |
Accepts assignment
Participating since Mar 1, 2020 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|
Home Life Healthcare, Corp.
Hoffman Estates, IL · CCN 148166 |
Home health agency |
5% Or Greater Direct Ownership Interest (100%) |
Oct 1, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| O20100930089879 |
NY |
DME Supplier - Pharmacy
DME Supplier - Medical Supply Company |
9830217637 |
Practice locations: Chittenango, NY |
| O20110921000274 |
NY |
Part B Supplier - Mass Immunization (Roster Biller Only) |
9830217637 |
This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Pharmacy |
333600000X |
022822 |
NY |
|
| Community/Retail Pharmacy |
3336C0003X |
|
|
Yes |
Addresses
Primary practice location
540 Genesee St.
Chittenango, NY 13037
Mailing address
29 E Main St
Gouverneur, NY 13642-1401
Phone (315) 287-3600
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 3311367 | Other | | OTHER ID NUMBER-COMMERCIAL NUMBER |
| 01622866 | Medicaid | NY | |
Other names
- Kinney Drugs #46 Doing business as
Other providers in Chittenango, NY
- Charles Louis Ingerson, R.N.
- John Jackson
- Tiffany Nicole Jackson, LMHC
- Whitney King
- Daniel G Kingsley, PT, OCS, COMT, CSCS
- Kudos Medical PLLC
- Erika C Lambert, MD
- Sean Laubenstein, DPT
- Cara E Lavier, FNP
- Samantha Guarrera Lawrence, DPT
All providers in Chittenango, NY
· Community/Retail Pharmacy in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.
Verify at the official NPI Registry.