1710965124 NPI number — MERCY HOSPITAL OF WATERTOWN UNITED STATES CATHOLIC CONFERENCE

Table of content: (NPI 1710965124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710965124 NPI number — MERCY HOSPITAL OF WATERTOWN UNITED STATES CATHOLIC CONFERENCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HOSPITAL OF WATERTOWN UNITED STATES CATHOLIC CONFERENCE
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:
GENESIS HEALTHCARE OF NEW YORK
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:
1710965124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
199 PRATT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13601-4349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-782-0415
Provider Business Mailing Address Fax Number:
315-786-0417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
199 PRATT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13601-4349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-782-0415
Provider Business Practice Location Address Fax Number:
315-786-0417
Provider Enumeration Date:
01/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRAY
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DPS/ADMINISTRATOR
Authorized Official Telephone Number:
315-782-0415

Provider Taxonomy Codes

  • Taxonomy code: 2472R0900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3104A0630X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01226553 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113538582 . This is a "COMM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 337254 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 344246 . This is a "GHI VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 113538582 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113538582 . This is a "COMM INS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P014001500 . This is a "BC ROCHESTER" identifier . This identifiers is of the category "OTHER".
  • Identifier: C52892A . This is a "1ST UNITED AMERICAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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