NPIMap

Organization Active NPI

KPH Healthcare Services, Inc.

Doing business as Kinney Drugs #44

  • Community/Retail Pharmacy
  • Elbridge, NY
National Provider Identifier
1881701068
Registry record updated Jul 4, 2024
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 #44
Practice address
1057 Route 5 East
Elbridge, NY 13060
Phone
(315) 689-6111
Fax
(315) 689-1628
NPI assigned
Aug 24, 2006
Last updated
Jul 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 4, 2024

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

Authorized official

Name
Elizabeth M Marlow
Title
Third Party Administrator
Phone
(315) 287-3600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 022450 NY
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

1057 Route 5 East
Elbridge, NY 13060

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
01550518MedicaidNY
3392456OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • Kinney Drugs #44 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930001895 NY DME Supplier - Pharmacy 9830217637 Practice locations: Elbridge, NY
O20110921000274 NY Part B Supplier - Mass Immunization (Roster Biller Only) 9830217637 This NPI is an additional NPI on the enrollment

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
KPH Healthcare Services, Inc.1057 Route 5 East, Elbridge, NY 13060(315) 689-6111 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 assignmentParticipating since Mar 1, 2020

National Provider Directory

National Provider Directory
Tax ID family
Kinney VT Drugs Inc No 2188 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

Member of 1

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

Locations

1057 State Route 5
Elbridge, NY 13060
Phone (315) 689-6111

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Home Life Healthcare, Corp.Hoffman Estates, IL, CCN 148166 Home health agency 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2020

Practitioners & affiliated clinicians

Practitioners 4

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": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720051200000",
    "number": "1881701068",
    "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": "1057 ROUTE 5 EAST",
            "city": "ELBRIDGE",
            "state": "NY",
            "postal_code": "13060",
            "telephone_number": "315-689-6111",
            "fax_number": "315-689-1628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KPH HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2024-07-04",
        "certification_date": "2024-07-04",
        "status": "A",
        "authorized_official_last_name": "MARLOW",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "M",
        "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": "022450",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01550518",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3392456",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kinney Drugs #44",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elbridge, NY

Sources for this page

Verify at the official NPI Registry.