Basic Information
| Provider Information | |||||||||
| NPI: | 1619222759 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GLENS FALLS HOSPITAL INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GRANVILLE FAMILY HEALTH | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 PARK STREET | ||||||||
| Address2: | GLENS FALLS HOSPITAL - CREDENTIALING | ||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128014413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189265924 | ||||||||
| FaxNumber: | 5189266983 | ||||||||
| Practice Location | |||||||||
| Address1: | 79 NORTH ST | ||||||||
| Address2: | GRANVILLE FAMILY HEALTH | ||||||||
| City: | GRANVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128321137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186420612 | ||||||||
| FaxNumber: | 5186420693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2012 | ||||||||
| LastUpdateDate: | 03/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | SCIMECA | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | INTERIM PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 5189265902 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GLENS FALLS HOSPITAL INC | ||||||||
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| NPICertificationDate: | 03/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | NY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207Q00000X | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.