Provider Demographics
NPI:1043262082
Name:ONEIDA COUNTY HOSPITAL PHYSICIANS GROUP
Entity type:Organization
Organization Name:ONEIDA COUNTY HOSPITAL PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / CEO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:V
Authorized Official - Last Name:WINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-766-2231
Mailing Address - Street 1:150 N 200 W
Mailing Address - Street 2:
Mailing Address - City:MALAD
Mailing Address - State:ID
Mailing Address - Zip Code:83252-1239
Mailing Address - Country:US
Mailing Address - Phone:208-766-2231
Mailing Address - Fax:208-766-4819
Practice Address - Street 1:150 N 200 W
Practice Address - Street 2:
Practice Address - City:MALAD
Practice Address - State:ID
Practice Address - Zip Code:83252-1239
Practice Address - Country:US
Practice Address - Phone:208-766-2231
Practice Address - Fax:208-766-4819
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONEIDA COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID41207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8M787OtherBLUECROSS OF ID
ID1252901Medicare Oscar/Certification