Basic Information
| Provider Information | |||||||||
| NPI: | 1760582142 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SCHUYLER HOSPITAL INC | ||||||||
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| OtherOrganizationName: | SCHUYLER HOSPITAL PHYSICIAN GROUP | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 STEUBEN ST | ||||||||
| Address2: | |||||||||
| City: | MONTOUR FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148659740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075358638 | ||||||||
| FaxNumber: | 6075354433 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 STEUBEN STREET | ||||||||
| Address2: | |||||||||
| City: | MONTOUR FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075357154 | ||||||||
| FaxNumber: | 6075357157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | O'CONNELL | ||||||||
| AuthorizedOfficialFirstName: | SUE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 6075358639 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | NY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 208600000X | NY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 207R00000X | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000012654 | 01 | NY | BCBS | OTHER |