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WYOMING COUNTY FAMILY MEDICINE, P.C.

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Company Details

Name: WYOMING COUNTY FAMILY MEDICINE, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 21 Aug 2019 (6 years ago)
Entity Number: 5607759
ZIP code: 14569
County: Wyoming
Place of Formation: New York
Address: 400 NORTH MAIN STREET, WARSAW, NY, United States, 14569

Contact Details

Phone +1 585-969-5335

Phone +1 585-591-2186

Phone +1 585-786-7907

Phone +1 585-492-5088

Phone +1 585-793-9230

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 400 NORTH MAIN STREET, WARSAW, NY, United States, 14569

National Provider Identifier

NPI Number:
1417594623
Certification Date:
2022-02-08

Authorized Person:

Name:
DALE DEAHN
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
No
Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
5854924681

Filings

Filing Number Date Filed Type Effective Date
191127000173 2019-11-27 CERTIFICATE OF AMENDMENT 2019-11-27
190821000059 2019-08-21 CERTIFICATE OF INCORPORATION 2019-08-21

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Date of last update: 23 Mar 2025

Sources: New York Secretary of State