CMS-1500 Box 24J / 33a • NPI
1174629489
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
311Z00000X
Licensed & Credentialed Custodial Care Facility
Box 32 Service Location & ZIP+4
SOUTH ROAD, C/O PHARMACY, GOWANDA, NY, 14070-0350
✓ 9-Digit EDI 837 ZIP+4 (14070-0350)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1174629489 (GOWANDA CORRECTIONAL FACILITY) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1174629489 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | GOWANDA CORRECTIONAL FACILITY |
| Plain-English Specialty | Licensed & Credentialed Custodial Care Facility NUCC Code: 311Z00000X (Custodial Care Facility) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | SOUTH ROAD, C/O PHARMACY, GOWANDA, NY, 14070-0350 |
| Practice Telephone / Fax | Tel: (716) 532-0177 | Fax: (716) 532-0177 |
| Administrative Mailing Address | PO BOX 350, GOWANDA, NY, 14070-0350 |
| Enumeration & Last Sync | Enumerated: 2006-09-15 | CMS Record Updated: 2020-08-22 |
| Authorized Official | RICHARD SAVAGE (Superintendent) |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (311Z00000X)
What Does Taxonomy Code 311Z00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 311Z00000X translates to:
"Licensed & Credentialed Custodial Care Facility"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (GOWANDA CORRECTIONAL FACILITY)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
311Z00000X — Custodial Care FacilityPlain English: Licensed & Credentialed Custodial Care Facility | State: NY | License: 022302 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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