Basic Information
| Provider Information | |||||||||
| NPI: | 1790727543 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SISTERS OF CHARITY HOSPITAL OF BUFFALO NEW YORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2157 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142142648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168621000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2157 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142142648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168621000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 09/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | BERGMANN | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 7168621900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 1401013H | NY | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0001413501 | 01 | NY | UNIVERA HEALTHCARE | OTHER | 04041000066 | 01 | NY | FIDELIS | OTHER | 050 | 01 | NY | HEALTHNOW | OTHER | 24 | 01 | NY | INDEPENDENT HEALTH | OTHER | 00354563 | 05 | NY | MEDICAID |