Organization
JEFFERSON COUNTY PUBLIC HEALTH SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORENA LOUISE KIMBALL (ACCOUNTANT)
(135) 786-3742
Entity
Organization
Contact information
Practice address
531 MEADE ST, WATERTOWN, NY 13601-1225
(315) 786-3710
(315) 786-3761
Mailing address
531 MEADE ST, WATERTOWN, NY 13601-1225
(315) 786-3710
(315) 786-3761
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
2201600
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00583711
—
NY
01
—
2201600
CHHA PROVIDER NUMBER
NY
Enumeration date
01/02/2007
Last updated
08/22/2020
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