1811917461 NPI number — ALBANY MEDICAL CENTER HOSPITAL

Table of content: (NPI 1811917461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811917461 NPI number — ALBANY MEDICAL CENTER HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBANY MEDICAL CENTER 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:
ALBANY MEDICAL CENTER SOUTH CLINICAL CAMPUS
Provider Other Organization Name Type Code:
3
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:
1811917461
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 HACKETT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12208-3420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-262-7476
Provider Business Mailing Address Fax Number:
518-262-6316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 HACKETT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12208-3420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-262-7476
Provider Business Practice Location Address Fax Number:
518-262-6316
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALBERT
Authorized Official First Name:
FRANCES
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
EXEC VICE PRESIDENT, CHIEF OPERATIN
Authorized Official Telephone Number:
518-262-3579

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0101000H , 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: 350249 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 100057 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 141813299 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000400664000 . This is a "BLUE SHIELD OF NENY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 141813299 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 42452 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01952712 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000006 . This is a "EMPIRE BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10030311 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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