NPIMap

Organization Active NPI

Middletown Community Health Center Inc

  • Pediatrics Physician
  • Middletown, NY
National Provider Identifier
1912047861
Registry record updated Mar 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MIDDLETOWN COMMUNITY HEALTH CENTER INC
Practice address
14 Grove Street
Middletown, NY 10940
Phone
(845) 344-2273
Fax
(845) 343-5390
NPI assigned
Feb 8, 2007
Last updated
Mar 25, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2011

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

Authorized official

Name
Mrs. Theresa Maloney
Title
Ceo
Phone
(845) 343-7614

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NY Primary

Addresses

Primary practice location

14 Grove Street
Middletown, NY 10940

Mailing address

PO Box 987
21 Orchard Street
Middletown, NY 10940-0987
Phone (845) 343-9614

Other identifiers 1

IdentifierTypeStateIssuer
00355931MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912047861. Details of each certification follow.

  • CCN 331124 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 331124

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MIDDLETOWN COMMUNITY HEALTH CENTER INC 3468
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 14, 2014
Last certification
Oct 14, 2014
Ownership / control type
For profit – corporation
Facility address
14 Grove Street
Middletown, NY 10940

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301011200000",
    "number": "1912047861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 987",
            "address_2": "21 ORCHARD STREET",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109400987",
            "telephone_number": "845-343-9614",
            "fax_number": "845-343-5390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 GROVE STREET",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "10940",
            "telephone_number": "845-344-2273",
            "fax_number": "845-343-5390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDDLETOWN COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2011-03-25",
        "status": "A",
        "authorized_official_last_name": "MALONEY",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "845-343-7614",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00355931",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, NY

Sources for this page

Verify at the official NPI Registry.