1689221517 NPI number — MARY IMOGENE BASSETT HOSPITAL

Table of content: (NPI 1689221517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689221517 NPI number — MARY IMOGENE BASSETT HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY IMOGENE BASSETT 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:
1689221517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 ATWELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COOPERSTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13326-1301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-547-3456
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1055 MADISON MARKETPLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13346-2343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-825-3100
Provider Business Practice Location Address Fax Number:
315-825-3017
Provider Enumeration Date:
08/26/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SWINKO
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
NETWORK CFO AND BMC VP
Authorized Official Telephone Number:
607-547-3096

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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