HUDSON HEADWATERS HEALTH NETWORK (NPI# 1740296177) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740296177 |
| Entity Type | Organization |
| Organization Name | HUDSON HEADWATERS HEALTH NETWORK |
| Practice Address |
24 Fairfield Ave Schroon Lake NY 12870-0292 |
| Mailing Address |
9 Carey Rd Queensbury NY 12804-7880 |
| Practice Telephone | 5185327120 |
| Practice Fax Number | 5185320593 |
| Mailing Telephone | 5187610300 |
| Mailing Fax Number | 5188242388 |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2020-02-03 |
| Authorized Official Name | CHRISTOPHER TOURNIER (EXECUTIVE VP OF FINANCE / CFO) |
| Authorized Official Telephone | 5187610300 |
| Is Organization Subpart | Y |
| Parent Organization Name | HUDSON HEADWATERS HEALTH NETWORK |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 104100000X | Social Worker | Behavioral Health & Social Service Providers | ||
| N | 133N00000X | Nutritionist | Dietary & Nutritional Service Providers | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 213E00000X | Podiatrist | Podiatric Medicine & Surgery Service Providers | ||
| N | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 03291018 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528611084 | Hudson Headwaters Health Network | Clinic/Center | 27 Hyland Dr, Lake Luzerne, NY 12846-3923 | 2019-07-23 |
| 1780030908 | Hudson Headwaters Health Network | Clinic/Center | 1 Glen St, Glens Falls, NY 12801-4439 | 2016-05-06 |
| 1427452200 | Hudson Headwaters Health Network | Family Medicine | 353 Schroon River Rd, Warrensburg, NY 12885-4807 | 2014-10-22 |
| 1386657534 | Hudson Headwaters Health Network | Nurse Practitioner | 28 S Western Ave, Queensbury, NY 12804-3323 | 2006-08-15 |
| 1952319386 | Hudson Headwaters Health Network | Social Worker | 101 Adirondack Drive, Suite 2, Ticonderoga, NY 12883 | 2006-08-03 |
| 1073529301 | Hudson Headwaters Health Network | Dentist | 3761 Main St, Warrensburg, NY 12885-1837 | 2006-07-31 |
| 1548276801 | Hudson Headwaters Health Network | Family Medicine | 6356 Nys Route 30, Indian Lake, NY 12842-2021 | 2006-07-31 |
| 1356355952 | Hudson Headwaters Health Network | Family Medicine | 1299 Route 9, Gansevoort, NY 12831-1560 | 2006-07-28 |
| 1295758423 | Hudson Headwaters Health Network | Family Medicine | 11 Cross St, Bolton Landing, NY 12814-0539 | 2006-07-26 |
| 1609899848 | Hudson Headwaters Health Network | Social Worker | 6223 State Route 9, Chestertown, NY 12817-2823 | 2006-07-26 |
| Street Address |
24 FAIRFIELD AVE |
| City | SCHROON LAKE |
| State | NY |
| Zip Code | 12870-0292 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194778464 | Kevin Andrew Gallagher | Family Medicine | 24 Fairfield Ave, Schroon Lake, NY 12870-0292 | 2006-05-18 |
| 1821454190 | Briana Sarah Bowden | Nurse Practitioner | 24 Fairfield Ave, Schroon Lake, NY 12870-0292 | 2016-01-02 |
| 1063767408 | Sarah M Thompson | Family Medicine | 24 Fairfield Ave, Schroon Lake, NY 12870-0292 | 2012-07-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891120796 | Kristie Amanda Keppler | Speech-Language Pathologist | 59 Fowler Ave., Schroon Lake, NY 12870 | 2013-09-10 |
| 1932338084 | Jeffrey Pearl | Pharmacist | 1081 Main St., Schroon Lake, NY 12870 | 2009-07-10 |
| 1326183963 | Adirondack Apothecary, LLC | Pharmacy | 1081 Main St, Schroon Lake, NY 12870 | 2007-02-21 |
| 1659385284 | Joseph J Schwerman | Family Medicine | 24 Fairfield Avenue, Schroon Lake, NY 12870-0292 | 2006-07-28 |
| 1205983723 | Schroon Lake Central School | Local Education Agency (LEA) | 1125 U.S. Route 9, Schroon Lake, NY 12870-0338 | 2007-01-05 |
| 1225173875 | Rebecca L Cole | Pharmacist | 1081 Main St, Schroon Lake, NY 12870-0458 | 2007-02-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891120796 | Kristie Amanda Keppler | Speech-Language Pathologist | 59 Fowler Ave., Schroon Lake, NY 12870 | 2013-09-10 |
| 1932338084 | Jeffrey Pearl | Pharmacist | 1081 Main St., Schroon Lake, NY 12870 | 2009-07-10 |
| 1205983723 | Schroon Lake Central School | Local Education Agency (LEA) | 1125 U.S. Route 9, Schroon Lake, NY 12870-0338 | 2007-01-05 |
| 1326183963 | Adirondack Apothecary, LLC | Pharmacy | 1081 Main St, Schroon Lake, NY 12870 | 2007-02-21 |
| 1225173875 | Rebecca L Cole | Pharmacist | 1081 Main St, Schroon Lake, NY 12870-0458 | 2007-02-21 |
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| Find all providers with the same taxonomy | ||||
| City | SCHROON LAKE |
| Zip Code | 12870 |
Please comment or provide details below to improve the information on HUDSON HEADWATERS HEALTH NETWORK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.