Provider Demographics
NPI:1033262258
Name:CITY OF HORNELL
Entity Type:Organization
Organization Name:CITY OF HORNELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MAYOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-324-7421
Mailing Address - Street 1:5530 SHERIDAN DR
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3730
Mailing Address - Country:US
Mailing Address - Phone:716-204-3350
Mailing Address - Fax:716-247-5274
Practice Address - Street 1:110 BROADWAY
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1518
Practice Address - Country:US
Practice Address - Phone:607-324-7421
Practice Address - Fax:607-324-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109753416L0300X
NY304663416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101217418 0001Medicaid
NY00931026Medicaid
NY590011390OtherPALMETTO
NY35114BMedicare PIN