1013985399 NPI number — ST JAMES HOSPITAL

Table of content: (NPI 1013985399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013985399 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:
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:
1013985399
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2020
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:
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:
607-324-8000
Provider Business Mailing Address Fax Number:
607-324-8198

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:
607-247-2200
Provider Business Practice Location Address Fax Number:
607-385-3196
Provider Enumeration Date:
03/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BECHER
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR DECISION SUPPORT
Authorized Official Telephone Number:
607-385-3960

Provider Taxonomy Codes

  • Taxonomy code: 282NR1301X , with the licence number:  5002001H , 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: 02702050 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00363162 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01198796 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01362234 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".