Provider Demographics
NPI:1730247156
Name:AHC GUTHRIE-DRUM
Entity type:Organization
Organization Name:AHC GUTHRIE-DRUM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ERB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-772-1755
Mailing Address - Street 1:11050 MOUNT BELVEDERE BLVD
Mailing Address - Street 2:UBO
Mailing Address - City:FORT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13602-5438
Mailing Address - Country:US
Mailing Address - Phone:315-772-4033
Mailing Address - Fax:315-772-1553
Practice Address - Street 1:11050 MOUNT BELVEDERE BLVD
Practice Address - Street 2:UBO
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602-5438
Practice Address - Country:US
Practice Address - Phone:315-772-4033
Practice Address - Fax:315-772-1553
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHC GUTHRIE-DRUM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-05
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
4400024OtherGHI
3311521OtherNCPDP
VAD000Medicare UPIN
OTH000Medicare UPIN