Provider Demographics
NPI:1982798781
Name:OLEAN MEDICAL GROUP PARTNERSHIP
Entity type:Organization
Organization Name:OLEAN MEDICAL GROUP PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-372-0141
Mailing Address - Street 1:14 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NY
Mailing Address - Zip Code:14727-1002
Mailing Address - Country:US
Mailing Address - Phone:585-968-3210
Mailing Address - Fax:585-968-3031
Practice Address - Street 1:14 CENTER ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1002
Practice Address - Country:US
Practice Address - Phone:585-968-3210
Practice Address - Fax:585-968-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03012168Medicaid
NY03012168Medicaid