1720299654 NPI number — CARTHAGE AREA HOSPITAL INC.

Table of content: (NPI 1720299654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720299654 NPI number — CARTHAGE AREA HOSPITAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARTHAGE AREA 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:
1720299654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 WEST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARTHAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13619-9703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-493-1000
Provider Business Mailing Address Fax Number:
315-493-0105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32787 US ROUTE 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-493-1000
Provider Business Practice Location Address Fax Number:
315-493-0105
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BECKER
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO ADMINISTRATOR
Authorized Official Telephone Number:
315-493-1000

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  2238001H , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QX0100X , with the licence number: 2238001H , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00310852 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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