1063400539 NPI number — EASTERN NIAGARA HOSPITAL, INC

Table of content: (NPI 1063400539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063400539 NPI number — EASTERN NIAGARA HOSPITAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN NIAGARA HOSPITAL, 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:
1063400539
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
521 EAST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOCKPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14094-3201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-514-5501
Provider Business Mailing Address Fax Number:
716-514-5549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 EAST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCKPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14094-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-514-5501
Provider Business Practice Location Address Fax Number:
716-514-5549
Provider Enumeration Date:
10/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ICKOWSKI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
716-514-5501

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 3101000H , 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: 00011412701 . This is a "UNIVERA BILLING #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000031000 . This is a "BCBS BILLING #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00354389 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000030000 . This is a "BCBS BILLING #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 13 . This is a "IHA BILLING #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 89 . This is a "IHA BILLING #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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