Basic Information
| Provider Information | |||||||||
| NPI: | 1144618257 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OLEAN MEDICAL GROUP PARTNERSHIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 535 MAIN ST | ||||||||
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| City: | OLEAN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147601500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163720141 | ||||||||
| FaxNumber: | 7163726421 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 WAYNE ST | ||||||||
| Address2: | |||||||||
| City: | OLEAN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147602355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163721570 | ||||||||
| FaxNumber: | 7163721556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2014 | ||||||||
| LastUpdateDate: | 12/26/2014 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | FRED | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN, EXECUTIVE BOARD | ||||||||
| AuthorizedOfficialTelephone: | 7163720141 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.