1003923434 NPI number — ST. LUKE'S CORNWALL HOSPITAL

Table of content: (NPI 1003923434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003923434 NPI number — ST. LUKE'S CORNWALL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. LUKE'S CORNWALL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003923434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 DUBOIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBURGH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12550-4851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-561-4400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 DUBOIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550-4851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-561-4400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARTON
Authorized Official First Name:
JILL
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF REVENUE CYCLE
Authorized Official Telephone Number:
845-568-2770

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  3522000H , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H04201 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10014302 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 04539 . This is a "BENEFIT PLAN ADMIN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 104575 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43910 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60966 . This is a "LOCAL 445" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 60966 . This is a "US HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 701715 . This is a "MVP HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: IC8857 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00156 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 273863 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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