1659360709 NPI number — BON SECOURS COMMUNITY HOSPITAL

Table of content: (NPI 1659360709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659360709 NPI number — BON SECOURS COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BON SECOURS COMMUNITY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659360709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT JERVIS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12771-2253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-858-7000
Provider Business Mailing Address Fax Number:
845-858-7415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT JERVIS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12771-2253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-858-7000
Provider Business Practice Location Address Fax Number:
845-858-7415
Provider Enumeration Date:
10/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LEAHY
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
845-368-5000

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000155 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4154304 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: US HEALTCARE . This is a "0012335" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000084602 . This is a "THREE RIVERS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0004836000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00273905 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4569 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 928114 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: H384535 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000043822 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1007778760003 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: IC0507 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: IC508 . This is a "PHS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5000031 . This is a "UNITED HEALTHCARE COMPLET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 811968 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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