Basic Information
| Provider Information | |||||||||
| NPI: | 1013184639 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. LUKE'S CORNWALL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 DUBOIS ST | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125504851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455614400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 70 DUBOIS ST | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125504851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455614400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2008 | ||||||||
| LastUpdateDate: | 05/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | ATZROTT | ||||||||
| AuthorizedOfficialFirstName: | ALLEN | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 8455614400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | 3522000H | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
ID Information
| ID | Type | State | Issuer | Description | 10014302 | 01 | CDPHP | OTHER | 43910 | 01 | MEDICARE GHI | OTHER | 04539 | 01 | BENEFIT PLAN ADMIN | OTHER | 104575 | 01 | MEDICAID WELLCARE | OTHER | 60966 | 01 | LOCAL 445 | OTHER | 60966 | 01 | US HEALTHCARE | OTHER | IC8857 | 01 | HEALTHNET | OTHER | 00156 | 01 | BLUE CROSS | OTHER | 273863 | 05 | NY | MEDICAID | 701715 | 01 | MVP HEALTH PLAN | OTHER | H04201 | 01 | OXFORD HEALTH PLAN | OTHER |