1689749640 NPI number — ST. PETERS HOSPITAL OF THE CITY OF ALBANY

Table of content: (NPI 1689749640)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689749640 NPI number — ST. PETERS HOSPITAL OF THE CITY OF ALBANY

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:
ST. PETERS HOSPITAL OF THE CITY OF ALBANY

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:
1689749640

Entity Type Code:
Organization

Replacement NPI:

Last Update Date:
08/09/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14890

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:
12212-4890

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PINE WEST PLAZA

Provider Second Line Business Practice Location Address:
SLEEP THERAPY EQUIPMENT

Provider Business Practice Location Address City Name:
ALBANY

Provider Business Practice Location Address State Name:
NY

Provider Business Practice Location Address Postal Code:
12205

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
518-275-4090

Provider Business Practice Location Address Fax Number:
518-275-4004

Provider Enumeration Date:
11/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KNOWLES

Authorized Official First Name:
COURTNEY

Authorized Official Middle Name:

Authorized Official Title or Position:
PAYER CREDENTIALING MANAGER

Authorized Official Telephone Number:
518-525-5634

Provider Taxonomy Codes

Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 282N00000X , with the licence number: 0101004H , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .