Provider Demographics
NPI: | 1033499017 |
---|---|
Name: | OLEAN GENERAL HOSPITAL |
Entity Type: | Organization |
Organization Name: | OLEAN GENERAL HOSPITAL |
Other - Org Name: | FOOTHILLS MEDICAL GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JILL |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | OWENS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 716-373-2600 |
Mailing Address - Street 1: | 908 NIAGARA FALLS BLVD STE 208 |
Mailing Address - Street 2: | |
Mailing Address - City: | NORTH TONAWANDA |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 14120-2019 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 716-799-1462 |
Mailing Address - Fax: | 833-953-2016 |
Practice Address - Street 1: | 515 MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | OLEAN |
Practice Address - State: | NY |
Practice Address - Zip Code: | 14760-1513 |
Practice Address - Country: | US |
Practice Address - Phone: | 716-373-2600 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-08-23 |
Last Update Date: | 2023-10-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 282N00000X | Hospitals | General Acute Care Hospital | ||
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Multi-Specialty |
No | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | Group - Multi-Specialty |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2080P0205X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | Group - Multi-Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
No | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 100775503 | Medicaid | |
NY | 03406388 | Medicaid |