Basic Information
| Provider Information | |||||||||
| NPI: | 1164473039 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARGARETVILLE MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42084 STATE HIGHWAY 28 | ||||||||
| Address2: | |||||||||
| City: | MARGARETVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124552820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455862631 | ||||||||
| FaxNumber: | 8459436077 | ||||||||
| Practice Location | |||||||||
| Address1: | 42084 STATE HIGHWAY 28 | ||||||||
| Address2: | |||||||||
| City: | MARGARETVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124552820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455862631 | ||||||||
| FaxNumber: | 8459436077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 08/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | HSU | ||||||||
| AuthorizedOfficialFirstName: | WAH-CHUNG | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8459436033 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 00279387 | 05 | NY | MEDICAID |