Basic Information
| Provider Information | |||||||||
| NPI: | 1235749979 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEWIS COUNTY GENERAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | LEWIS COUNTY GENERAL HOSPITAL | ||||||||
| Address2: | 7785N STATE ST | ||||||||
| City: | LOWVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153765246 | ||||||||
| FaxNumber: | 3153769317 | ||||||||
| Practice Location | |||||||||
| Address1: | COPENHAGEN HEALTH CENTER | ||||||||
| Address2: | 9732 STATE ROUTE 12 | ||||||||
| City: | COPENHAGEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136261362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3156882305 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2020 | ||||||||
| LastUpdateDate: | 08/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | PRINCE | ||||||||
| AuthorizedOfficialFirstName: | MICHELE | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3153765246 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 03304574 | 05 | NY | MEDICAID |