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Contact Information

MOUNTAIN MEDICAL OF WATERTOWN
457 GAFFNEY DR
WATERTOWN, NY13601
 Phone: 315-779-2273
 Fax: 315-779-2274
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for MOUNTAIN MEDICAL OF WATERTOWN

NPI Number 1306068812
LBN Legal business name MOUNTAIN MEDICAL OF WATERTOWN
Authorized official MARK KNOWLES - (PA)
Entity Organization
Organization subpart 1 No
Enumeration date 05/03/2007
Last updated 08/22/2020 - About 6 years ago
Identifiers
NY License # 001608-1
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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