1124233788 NPI number — UNITED HEALTH SERVICES HOSPITALS, INC

Table of content: (NPI 1124233788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124233788 NPI number — UNITED HEALTH SERVICES HOSPITALS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED HEALTH SERVICES HOSPITALS, INC
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:
1124233788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10-42 MITCHELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BINGHAMTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13903-1617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-762-3006
Provider Business Mailing Address Fax Number:
607-762-2065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10-42 MITCHELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BINGHAMTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13903-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-762-3027
Provider Business Practice Location Address Fax Number:
607-762-2065
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KEARNEY O'BRIEN
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, THIRD PARTY REIMBURSEMENT
Authorized Official Telephone Number:
607-762-3078

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1678A . This is a "MVP - PSYCH MD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 33V394 . This is a "EXCELLUS - ARU" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1678B . This is a "MVP - PSYCH SOC WORKER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 44567 . This is a "AETNA - NON HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5709 . This is a "GHI - NON COMMERCIAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 33Z394 . This is a "EXCELLUS - BIU" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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