Provider Demographics
NPI:1538187075
Name:FAMILY MEDICINE MEDICAL SERVICE GROUP
Entity type:Organization
Organization Name:FAMILY MEDICINE MEDICAL SERVICE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:EPLING
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:315-464-7003
Mailing Address - Street 1:475 IRVING AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-464-4686
Mailing Address - Fax:315-464-7106
Practice Address - Street 1:475 IRVING AVE
Practice Address - Street 2:STE 300
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-4686
Practice Address - Fax:315-464-7106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00482320Medicaid
NY34820AMedicare PIN
34820AMedicare UPIN
NY00482320Medicaid
56751AMedicare PIN