HUDSON HEADWATERS HEALTH NETWORK - NPI 1679358873 - Clinic/Center in Lake Placid, NY

Q: What is Hudson Headwaters Health Network's NPI number?

The NPI number for Hudson Headwaters Health Network is 1679358873. It was assigned to this organization in the NPPES registry on August 28, 2023.

Q: What is Hudson Headwaters Health Network's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

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About Hudson Headwaters Health Network NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HUDSON HEADWATERS HEALTH NETWORK (NPI 1679358873) is a healthcare organization registered as a primary care in Lake Placid, New York and active in the NPI registry since August 2023. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Laura Pasco, Executive Vp, Cfo, as its authorized official.

NPPES Registry Identity

NPI1679358873

Entity TypeOrganization

Primary Taxonomy261QP2300X

Legal Business NameHUDSON HEADWATERS HEALTH NETWORK

Location Address203 OLD MILITARY RDLake Placid, NY 12946-1738

Mailing Address9 Carey RdQueensbury, NY 12804-7880 · (518) 761-0300 · Fax (518) 824-2388

Phone(518) 824-2564

Fax(833) 448-3029

Organization SubpartYes

Authorized OfficialLaura PascoExecutive Vp, Cfo · (518) 761-0300

Enumeration DateAugust 28, 2023

Last NPPES UpdateFebruary 24, 2024

NPPES CertifiedFebruary 24, 2024

✔ NPI 1679358873 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities

Taxonomy Code261QP2300X

Also ListedFamily MedicineTaxonomy 207Q00000X

Also ListedInternal MedicineTaxonomy 207R00000X

Also ListedClinic/Center · Federally Qualified Health Center (FQHC)Taxonomy 261QF0400X

Also ListedPhysician AssistantTaxonomy 363A00000X

Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X

203 OLD MILITARY RD, Lake Placid, NY 12946

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D2304509

Hudson Headwaters Family Health At Lake Placid · Lake Placid, NY

Active · expires Mar 26, 2027

CLIA Number33D2304509

Laboratory TypeFederally Qualified Health Center

Certificate Effective DateMay 14, 2024

Certificate Expiration DateMarch 26, 2027

Laboratory DirectorKevin A. Gallagher

Laboratory Phone(518) 824-2564

Laboratory LocationHudson Headwaters Family Health At Lake Placid203 Old Military Rd, Lake Placid, NY 12946

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. TRACEY A VIOLA D.O.

Family Medicine (Sports Medicine)