1891907929 NPI number — MRS. S. DIANNE MERCER SNEATH OTR

Table of content: MRS. S. DIANNE MERCER SNEATH OTR (NPI 1891907929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891907929 NPI number — MRS. S. DIANNE MERCER SNEATH OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNEATH
Provider First Name:
S. DIANNE
Provider Middle Name:
MERCER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERCER
Provider Other First Name:
SHARON
Provider Other Middle Name:
DIANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891907929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4765 BICKERT DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARENCE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14031-2206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-572-1926
Provider Business Mailing Address Fax Number:
716-759-6069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WYOMING COUNTY COMMUNITY HOSPITAL
Provider Second Line Business Practice Location Address:
400 NORTH MAIN STREET
Provider Business Practice Location Address City Name:
WARSAW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-786-2233
Provider Business Practice Location Address Fax Number:
585-786-1268
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  003009-1 , 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)





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