Organization
GENESEE VALLEY GROUP HEALTH ASSOCIATION
Active
Other names
Lifetime Health Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH CARLASCIO (VICE PRESIDENT REGIONAL OPERATIONS)
(585) 338-1400
Entity
Organization
Contact information
Practice address
899 MAIN ST, BUFFALO, NY 14203-1109
(716) 878-2700
Mailing address
899 MAIN ST, BUFFALO, NY 14203-1109
(716) 878-2700
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000513370010
BCBS GROUP NUMBER AH
NY
Enumeration date
03/16/2007
Last updated
08/22/2020
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