| NPI | 1235537655 |
|---|---|
| Other Name | MOBILE VAN UNIT |
| Entity Type | Organization |
| Authorized Contact | DAVID H SHIPPEE CEO/President 518-465-4771 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: NY 0101205R) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: NY 0101205R) |
| 261QP2300X Clinic/Center, Primary Care (Licence: NY 010120R) | |
| Enumeration Date | 2014-12-17 |
| Last Update Date | 2014-12-17 |