Basic Information
| Provider Information | |||||||||
| NPI: | 1811977796 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. MARY'S HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 427 GUY PARK AVE | ||||||||
| Address2: | |||||||||
| City: | AMSTERDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120101054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188421900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 427 GUY PARK AVE | ||||||||
| Address2: | |||||||||
| City: | AMSTERDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120101054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188421900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 07/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | GIULIANELLI | ||||||||
| AuthorizedOfficialFirstName: | VICTOR | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 5188417101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 2801001H | NY | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 00351639 | 05 | NY | MEDICAID |