Organization
ST LAWRENCE COUNTY
Active
Parent organization
ST LAWRENCE COUNTY
Other names
St Lawrence County Public Health - Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST LAWRENCE COUNTY
Authorized official
DEBRA BRIDGES MBA (FISCAL MANAGER)
(315) 229-3405
Entity
Organization
Contact information
Practice address
80 STATE HIGHWAY 310 STE 2, CANTON, NY 13617-1476
(315) 386-2325
(315) 386-2203
Mailing address
80 STATE HIGHWAY 310 STE 2, CANTON, NY 13617-1476
(315) 386-2325
(315) 386-2203
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
4423200R
NY
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04006057
—
NY
Enumeration date
12/06/2006
Last updated
12/01/2015
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