Provider Demographics
NPI:1588758635
Name:COLUMBIA COUNTY
Entity type:Organization
Organization Name:COLUMBIA COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMOTHY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPA
Authorized Official - Phone:518-828-3358
Mailing Address - Street 1:325 COLUMBIA ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1905
Mailing Address - Country:US
Mailing Address - Phone:518-828-3358
Mailing Address - Fax:518-828-5894
Practice Address - Street 1:325 COLUMBIA ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1905
Practice Address - Country:US
Practice Address - Phone:518-828-3358
Practice Address - Fax:518-828-5894
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1001601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
10002521OtherCAPITAL DISTRICT PHP
NY00473258Medicaid
2301493OtherAETNA US HEALTHCARE
000400261001OtherBLUE SHIELD NENY
986047OtherMVP
000000013641OtherGHI HMO
004569OtherEMPIRE BCBS
000400261001OtherBLUE CROSS BLUE SHIELD
040401000513OtherFIDELIS CARE OF NY
000000013641OtherGHI HMO
000400261001OtherBLUE SHIELD NENY
10002521OtherCAPITAL DISTRICT PHP
=========OtherAPA PARTNERS
=========OtherCIGNA
000400261001OtherBLUE SHIELD NENY
004569OtherEMPIRE BCBS