HUDSON HEADWATERS HEALTH NETWORK NPI 1386657534

NPI Information

NPI: 1386657534
Provider Name: HUDSON HEADWATERS HEALTH NETWORK
Classification: Clinic/Center - 261QP2300X
Specialization: Primary Care
Entity Type: Organization
CLIA Number: 33D2192460
Address: 28 S WESTERN AVE
QUEENSBURY, NY
ZIP 12804
Phone: (518) 798-6400

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NPI Details

HUDSON HEADWATERS HEALTH NETWORK is a primary care clinic center in Queensbury, NY. HUDSON HEADWATERS HEALTH NETWORK NPI is 1386657534. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

28 S WESTERN AVE
QUEENSBURY, NY
ZIP 12804-323
Phone: (518) 798-6400
Fax: (518) 798-4105

The provider's authorized official is Laura Pasco .
The authorized official title is Executive Vp, Cfo and has the following contact phone number (518) 761-0300.

The CLIA number assigned to this NPI record is 33D2192460 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/15/2006 and was last updated on 2/23/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License State	Primary
1	208000000X	Pediatrics		NEW YORK	No
2	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)		No
3	363L00000X	Nurse Practitioner		NEW YORK	No
4	261QP2300X	Clinic/Center	Primary Care		Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	03289663	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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