Basic Information
Provider Information | |||||||||
NPI: | 1891862579 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BASSETT HOSPITAL OF SCHOHARIE COUNTY | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 178 GRANDVIEW DR | ||||||||
Address2: |   | ||||||||
City: | COBLESKILL | ||||||||
State: | NY | ||||||||
PostalCode: | 120435144 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5182543456 | ||||||||
FaxNumber: | 5182344839 | ||||||||
Practice Location | |||||||||
Address1: | 178 GRANDVIEW DR | ||||||||
Address2: |   | ||||||||
City: | COBLESKILL | ||||||||
State: | NY | ||||||||
PostalCode: | 120435144 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5182543456 | ||||||||
FaxNumber: | 5182344839 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/29/2006 | ||||||||
LastUpdateDate: | 12/10/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MARRYOTT | ||||||||
AuthorizedOfficialFirstName: | EDWARD | ||||||||
AuthorizedOfficialMiddleName: | MARK | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF REVENUE CYCLE | ||||||||
AuthorizedOfficialTelephone: | 6075476947 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | 4720001H | NY | N |   | Hospitals | General Acute Care Hospital | Rural | 282NC0060X |   |   | Y |   | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
ID | Type | State | Issuer | Description | 00302429 | 05 | NY |   | MEDICAID |