NPIMap

KPH Healthcare Services, Inc.

Organization Active NPI Community/Retail Pharmacy · Whitesboro, NY

NPI 1912949330 · NPPES record last updated Jul 4, 2024

Key facts

NPI
1912949330
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
027850 (NY)
Legal business name
KPH HEALTHCARE SERVICES, INC.
Practice address
40 Oriskany Blvd
Whitesboro, NY 13492-1318
Phone
(315) 292-1374
NPI assigned
Jun 11, 2006
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 16

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

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

Practitioners 3

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 numberLaboratoryCertificateExpires
33D2186237Kinney Drugs No 83
40 Oriskany Blvd, Whitesboro, NY 13492		Certificate of waiverMar 26, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
KPH Healthcare Services Inc
40 Oriskany Blvd, Whitesboro, NY 13492-1318 · (315) 292-1374		 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.

FacilityTypeRoleSince
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 IDStateProvider typePAC IDDetails
O20100930024296 NY DME Supplier - Pharmacy
DME Supplier - Medical Supply Company With Registered Pharmacist		 9830217637 Practice locations: Whitesboro, NY
O20110921000274 NY Part B Supplier - Mass Immunization (Roster Biller Only) 9830217637 This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Kinney Drugs Inc 26 (87 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 027850 NY Yes

Addresses

Primary practice location

40 Oriskany Blvd
Whitesboro, NY 13492-1318

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
02753437MedicaidNY

Other names

  • Kinney Drugs #83 Doing business as

Other providers in Whitesboro, NY

All providers in Whitesboro, NY · Community/Retail Pharmacy in New York

Sources for this page

Verify at the official NPI Registry.