Basic Information
| Provider Information | |||||||||
| NPI: | 1093362915 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARY IMOGENE BASSETT HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | BASSETT HEALTHCARE - COBLESKILL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 ATWELL RD | ||||||||
| Address2: | |||||||||
| City: | COOPERSTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133261301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075473459 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 136 PARKWAY DR | ||||||||
| Address2: | |||||||||
| City: | COBLESKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120435150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182342555 | ||||||||
| FaxNumber: | 5182343415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2019 | ||||||||
| LastUpdateDate: | 08/27/2019 | ||||||||
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| AuthorizedOfficialLastName: | SWINKO | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | NETWORK CFO AND BMC VP | ||||||||
| AuthorizedOfficialTelephone: | 6075473096 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.