1962618405 NPI number — ERIE COUNTY MEDICAL CENTER CORPORATION

Table of content: (NPI 1962618405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962618405 NPI number — ERIE COUNTY MEDICAL CENTER CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERIE COUNTY MEDICAL CENTER CORPORATION
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:
SKILLED NURSING FACILITY - ERIE COUNTY HOME
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:
1962618405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
462 GRIDER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14215-3021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-898-5931
Provider Business Mailing Address Fax Number:
716-898-5178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
462 GRIDER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14215-3021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-898-5931
Provider Business Practice Location Address Fax Number:
716-898-5178
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCARTHY
Authorized Official First Name:
SUE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
716-898-5931

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1401005N , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: 1420300N , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 11412205 . This is a "UNIVERA SKILLED NURSING" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000250000 . This is a "BLUE CROSS ERIE CTY HOME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11439102 . This is a "UNIVERA ERIE COUNTY HOME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 312327 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000319000 . This is a "BLUE CROSS SKILLED NURSIN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 708205 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: I3 . This is a "IHA SKILLED NURSING" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: J7 . This is a "IHA ERIE COUNTY HOME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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