NPIMap

Organization Active NPI

St Lawrence County

  • Multi-Specialty Clinic/Center
  • Canton, NY
National Provider Identifier
1861551822
Registry record updated Dec 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
4423200R Issued in NY
Legal business name
ST LAWRENCE COUNTY
Practice address
80 State Highway 310 Ste 2
Canton, NY 13617-1476
Phone
(315) 386-2325
Fax
(315) 386-2203
NPI assigned
Dec 6, 2006
Organization subpart
Yes
Parent organization
ST LAWRENCE COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 1, 2015

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

Authorized official

Name
Debra Bridges, MBA
Title
Fiscal Manager
Phone
(315) 229-3405

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Multi-Specialty Clinic/Center 261QM1300X 4423200R NY Primary

Addresses

Primary practice location

80 State Highway 310 Ste 2
Canton, NY 13617-1476

Mailing address

80 State Highway 310 Ste 2
Canton, NY 13617-1476
Phone (315) 386-2325

Other identifiers 1

IdentifierTypeStateIssuer
04006057MedicaidNY

Other names 1

  • St Lawrence County Public Health - Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140811000116 NY Part B Supplier - Clinic/Group Practice 9436249224 Receives reassigned benefits from 3 practitioners
Practice locations: Canton, NY

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
St Lawrence County Publ

Locations

80 State Highway 310
Ste 2
Canton, NY 13617
Phone (315) 386-2325

Practitioners & affiliated clinicians

Practitioners 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448928000000",
    "number": "1861551822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 STATE HIGHWAY 310 STE 2",
            "city": "CANTON",
            "state": "NY",
            "postal_code": "136171476",
            "telephone_number": "315-386-2325",
            "fax_number": "315-386-2203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 STATE HIGHWAY 310 STE 2",
            "city": "CANTON",
            "state": "NY",
            "postal_code": "136171476",
            "telephone_number": "315-386-2325",
            "fax_number": "315-386-2203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LAWRENCE COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST LAWRENCE COUNTY",
        "enumeration_date": "2006-12-06",
        "last_updated": "2015-12-01",
        "status": "A",
        "authorized_official_last_name": "BRIDGES",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "FISCAL MANAGER",
        "authorized_official_telephone_number": "315-229-3405",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NY",
            "license": "4423200R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04006057",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Lawrence County Public Health - Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canton, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2015; 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.