1699839431 NPI number — ST. JAMES HOSPITAL

Table of content: (NPI 1699839431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699839431 NPI number — ST. JAMES HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. JAMES 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:
SOUTHERN TIER HEALTH ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1699839431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 CANISTEO ST
Provider Second Line Business Mailing Address:
3RD FLOOR LINCOLN SCHOOL
Provider Business Mailing Address City Name:
HORNELL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14843-2104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-324-8294
Provider Business Mailing Address Fax Number:
607-324-8766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7329 SENECA ROAD NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HORNELL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-385-3960
Provider Business Practice Location Address Fax Number:
607-385-3195
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN STAFF COORDINATOR
Authorized Official Telephone Number:
607-324-8294

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01198498 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0075639 . This is a "GHI GROUP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "TRICARE GROUP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com