1962422733 NPI number — CAYUGA MEDICAL CENTER AT ITHACA

Table of content: (NPI 1962422733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962422733 NPI number — CAYUGA MEDICAL CENTER AT ITHACA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAYUGA MEDICAL CENTER AT ITHACA
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:
1962422733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 DATES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ITHACA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14850-1342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-274-4443
Provider Business Mailing Address Fax Number:
607-274-4527

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 DATES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ITHACA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14850-1342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-274-4443
Provider Business Practice Location Address Fax Number:
607-274-4527
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUDD
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VP/CFO
Authorized Official Telephone Number:
607-274-4443

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  5401001H , 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: 365593 . This is a "MVP PROVIDER NO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00332729 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7051 . This is a "TOTAL CARE CLINIC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7300101 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 284215 . This is a "HEALTHLINK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7051 . This is a "TOTAL CARE URG" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 908422 . This is a "HARVARD PILGRIM URG CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 925405 . This is a "CONNECTICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N49651 . This is a "HEALTHNET CLIN LAB" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00011438301 . This is a "UNIVERA PROVIDER NO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NY0101 . This is a "JOHN DEERE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7516 . This is a "TOTAL CARE EMERGENCY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5401001H . This is a "NYS PROVIDER/OPER CERT #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 900266 . This is a "HARVARD PILGRIM HOSP ED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NY7693 . This is a "HEALTHNET HOSP URG CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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