1982625661 NPI number — NICHOLAS H. NOYES MEMORIAL HOSPITAL

Table of content: (NPI 1982625661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982625661 NPI number — NICHOLAS H. NOYES MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NICHOLAS H. NOYES MEMORIAL 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:
1982625661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 CLARA BARTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14437-9503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-335-6001
Provider Business Mailing Address Fax Number:
585-335-2769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 CLARA BARTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-335-6001
Provider Business Practice Location Address Fax Number:
585-335-2769
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRUNOSKE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
585-335-6001

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  2527000H , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 2527000H , 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: 000000068000 . This is a "BLUE CROSS OF WESTERN NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 068 . This is a "COMMUNITY SENIOR BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 08S . This is a "EXCELLUS OF ROCHESTER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1030788D . This is a "COMMUNITY BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0014060920001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100002CF . This is a "COMMUNITY BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 100002CCF . This is a "COMMUNITY BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000011000010 . This is a "FIDELIS CARE NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00354476 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 014006208S . This is a "EXCELLUS OF ROCHESTER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 08 . This is a "EXCELLUS OF ROCHESTER NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01206208 . This is a "FAMILY FIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4159900 . This is a "NEW JERSEY MEDICAID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6450545 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010046248 . This is a "EXCELLUS OF ROCHESTER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 08 . This is a "EXCELLUS OF ROCHESTER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 095777100 . This is a "FLORIDA MEDICAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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