Basic Information
| Provider Information | |||||||||
| NPI: | 1275553521 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERTRAND CHAFFEE HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 EAST MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141411443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165922871 | ||||||||
| FaxNumber: | 7165928113 | ||||||||
| Practice Location | |||||||||
| Address1: | 224 EAST MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141411443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165922871 | ||||||||
| FaxNumber: | 7165928113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 12/31/2019 | ||||||||
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| AuthorizedOfficialLastName: | HEBDON | ||||||||
| AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7165929643 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | 12/31/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 1427000H | NY | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 00354150 | 05 | NY | MEDICAID | 000000040000 | 01 | NY | BLUE CROSS OF WESTERN NY | OTHER |