Organization Name: | VESTAL HEALTHCARE, LLC |
NPI Number: | 1063814333 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK R. FAWCETT (VP AND TREASUER) |
Mailing Address: | 373 Church St. Saratoga Springs |
State: | NY US |
Postal Code: | 128668626 |
Phone Number: | 5184346565 |
Fax Number: | 5184346611 |
NPI Enumeration Date: | 09/18/2014 |
NPI Last Update Date: | 04/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |