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CANTON-POTSDAM MEDICAL PRACTICE, PLLC

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Company Details

Name: CANTON-POTSDAM MEDICAL PRACTICE, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 22 Jun 2012 (13 years ago)
Entity Number: 4262582
ZIP code: 13676
County: St. Lawrence
Place of Formation: New York
Address: ATTN: DAVID ACKER, 50 LEROY STREET, POTSDAM, NY, United States, 13676

Contact Details

Phone +1 315-265-3300

Phone +1 315-262-2287

Phone +1 315-769-1667

Phone +1 315-261-6013

Phone +1 315-261-6012

Phone +1 315-265-0524

Phone +1 315-287-1000

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent ATTN: DAVID ACKER, 50 LEROY STREET, POTSDAM, NY, United States, 13676

National Provider Identifier

NPI Number:
1760821417
Certification Date:
2024-11-13

Authorized Person:

Name:
ASHLEY PEGGS
Role:
PROVIDER ENROLLMENT MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
261QM1300X - Multi-Specialty Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
3152616025

Filings

Filing Number Date Filed Type Effective Date
200603061045 2020-06-03 BIENNIAL STATEMENT 2020-06-01
180604008925 2018-06-04 BIENNIAL STATEMENT 2018-06-01
160615006117 2016-06-15 BIENNIAL STATEMENT 2016-06-01
140925000353 2014-09-25 CERTIFICATE OF AMENDMENT 2014-09-25
140605006188 2014-06-05 BIENNIAL STATEMENT 2014-06-01

Tax Exempt

Employer Identification Number (EIN) :
46-0714367
In Care Of Name:
% RICHARD D JACOBS
Classification:
Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Ruling Date:
2015-02
National Taxonomy Of Exempt Entities:
Voluntary Health Associations & Medical Disciplines: Medical Disciplines
Deductibility:
Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Determination Letters

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Date of last update: 26 Mar 2025

Sources: New York Secretary of State