Provider Demographics
NPI:1043353618
Name:SOLDIERS & SAILORS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SOLDIERS & SAILORS MEMORIAL HOSPITAL
Other - Org Name:SOLDIERS & SAILORS MEMORIAL HOSPITAL HOSPITALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER & CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-787-4030
Mailing Address - Street 1:418 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1070
Mailing Address - Country:US
Mailing Address - Phone:315-787-4150
Mailing Address - Fax:315-787-4794
Practice Address - Street 1:418 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1070
Practice Address - Country:US
Practice Address - Phone:315-787-4150
Practice Address - Fax:315-787-4794
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOLDIERS & SAILORS MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-14
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02657812Medicaid
NY02657812Medicaid