Great Lakes Physician Practice PC
Great Lakes Physician Practice PC is a healthcare organization registered as Internal Medicine Physician in Jamestown, NY, holding Type 2 (organization) NPI 1730599176 since 2014. The authorized official on file is Patricia Devlin, Sr.Director.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1730599176 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Great Lakes Physician Practice PC |
| Practice address | 15 S MAIN ST, Jamestown, NY, 14701 |
| Phone | 7164881877 |
| Fax | 7164881986 |
| Enumeration date | 2014-05-07 |
| Last updated in NPPES | 2020-02-03 |
Authorized official
| Name | Patricia Devlin |
|---|---|
| Title | Sr.Director |
| Phone | 4124327469 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 207RP1001X | Pulmonary Disease Physician | Secondary | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | Secondary | — | — |
| 207X00000X | Orthopaedic Surgery Physician | Secondary | — | — |
| 207Y00000X | Otolaryngology Physician | Secondary | — | — |
| 208600000X | Surgery Physician | Secondary | — | — |
| 207P00000X | Emergency Medicine Physician | Secondary | — | — |
| 207Q00000X | Family Medicine Physician | Secondary | — | — |
| 207RC0000X | Cardiovascular Disease Physician | Secondary | — | — |
| 207RG0100X | Gastroenterology Physician | Secondary | — | — |
| 207RN0300X | Nephrology Physician | Secondary | — | — |
| 207R00000X | Internal Medicine Physician | Primary | — | — |
Copy-ready billing details
Provider: Great Lakes Physician Practice PC NPI: 1730599176 Taxonomy: 207R00000X (Internal Medicine Physician) Address: 15 S MAIN ST, Jamestown, NY, 14701
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1609869973 | Christopher Hayes | Individual | Family Medicine Physician | Jamestown, NY |
| 1972573277 | Russell Lee | Individual | Surgery Physician | Jamestown, NY |
| 1528010766 | Jamestown Area Medical Associates, L.L.P. | Organization | Internal Medicine Physician | Jamestown, NY |
| 1194762211 | Frank Arnal | Individual | Pulmonary Disease Physician | Jamestown, NY |
| 1255378980 | Ginny Moyer-Matteson | Individual | Medical Physician Assistant | Jamestown, NY |
| 1265471619 | Keith Kulju | Individual | Gastroenterology Physician | Jamestown, NY |
| 1154360147 | George So | Individual | Cardiovascular Disease Physician | Jamestown, NY |
| 1760421655 | Blesilda So | Individual | Obstetrics & Gynecology Physician | Jamestown, NY |
Verify this record
Cross-check NPI 1730599176 against the authoritative CMS record: view Great Lakes Physician Practice PC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
Where is Great Lakes Physician Practice PC located?
How current is this record?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2020-02-03.