Basic Information
Provider Information | |||||||||
NPI: | 1649251554 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | GARNET HEALTH MEDICAL CENTER CATSKILLS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CATSKILL REGIONAL MEDICAL CENTER | ||||||||
OtherOrganizationType: | 4 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 900 | ||||||||
Address2: |   | ||||||||
City: | HARRIS | ||||||||
State: | NY | ||||||||
PostalCode: | 127420900 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8457943300 | ||||||||
FaxNumber: | 8457941052 | ||||||||
Practice Location | |||||||||
Address1: | 8881 ROUTE 97 | ||||||||
Address2: |   | ||||||||
City: | CALLICOON | ||||||||
State: | NY | ||||||||
PostalCode: | 12723 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8458875530 | ||||||||
FaxNumber: | 8458875380 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/08/2005 | ||||||||
LastUpdateDate: | 05/28/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DAVISON | ||||||||
AuthorizedOfficialFirstName: | ROBERT | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR OF BUDGET REIMBURSEMENT | ||||||||
AuthorizedOfficialTelephone: | 8453337446 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/28/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 5263700C | NY | Y |   | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
ID | Type | State | Issuer | Description | 00273978 | 05 | NY |   | MEDICAID |