1033270699 NPI number — CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER

Table of content: (NPI 1033270699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033270699 NPI number — CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER
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:
ACUTE
Provider Other Organization Name Type Code:
5
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:
1033270699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2868
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLATTSBURGH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12901-0259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-561-2000
Provider Business Mailing Address Fax Number:
518-561-0881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 BEEKMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-561-2000
Provider Business Practice Location Address Fax Number:
518-561-0881
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEBEAU
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/COO
Authorized Official Telephone Number:
518-562-7055

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0901001H , 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: 13551 . This is a "GHI-FHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00919 . This is a "EMPIRE BC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00919 . This is a "UHC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 114406 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000400019000 . This is a "BS NENY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10013988 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 330250 . This is a "EXCELLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 110089800 . This is a "USDL-WC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 90031 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00318814 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60054 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 61101 . This is a "GHI-NYC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 109703800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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