1477667145 NPI number — BELLEVUE WOMAN'S MEDICAL CENTER, INC.

Table of content: (NPI 1477667145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477667145 NPI number — BELLEVUE WOMAN'S MEDICAL CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELLEVUE WOMAN'S MEDICAL CENTER, 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:
6
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:
1477667145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2210 TROY ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NISKAYUNA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12309-4797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-346-9400
Provider Business Mailing Address Fax Number:
518-346-9416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2210 TROY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NISKAYUNA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12309-4797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-346-9400
Provider Business Practice Location Address Fax Number:
518-346-9416
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUSKO
Authorized Official First Name:
COLLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
518-346-9411

Provider Taxonomy Codes

  • Taxonomy code: 282NW0100X , with the licence number:  4652001H , 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: 000400031002 . This is a "BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000931 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0103 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00354132 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10005735 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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