1912253881 NPI number — COLUMBIA MEMORIAL HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912253881 NPI number — COLUMBIA MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA MEMORIAL 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:
6
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:
1912253881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12534-2000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-828-8363
Provider Business Mailing Address Fax Number:
518-697-3388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 PROSPECT AVE
Provider Second Line Business Practice Location Address:
SUITE L10
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12534-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-828-9988
Provider Business Practice Location Address Fax Number:
518-828-9980
Provider Enumeration Date:
07/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DINGMAN
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
518-828-8249

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  1001000H , 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: W79533 . This is a "MEDICARE GROUP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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