1801886072 NPI number — ST. CLARES HOSPITAL

Table of content: (NPI 1801886072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801886072 NPI number — ST. CLARES HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. CLARES 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:
1801886072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 MCCLELLAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHENECTADY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12304-1009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-347-5660
Provider Business Mailing Address Fax Number:
518-347-5409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MCCLELLAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12304-1009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-347-5666
Provider Business Practice Location Address Fax Number:
518-347-5409
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GASPAROVIC
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF FINANCE, CFO
Authorized Official Telephone Number:
518-347-5666

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  4601002H , 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: 000926 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040401000452 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10005832 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00361748 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000400036000 . This is a "BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 04606 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 025 . This is a "MOHAWK VALLEY PHYSICIANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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