Provider Demographics
NPI:1043394745
Name:MOUNT ST. MARY'S HOSPITAL OF NIAGARA FALLS
Entity Type:Organization
Organization Name:MOUNT ST. MARY'S HOSPITAL OF NIAGARA FALLS
Other - Org Name:MOUNT ST. MARY'S HOSPITAL AND HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANESS
Authorized Official - Suffix:
Authorized Official - Credentials:CHE
Authorized Official - Phone:716-298-2004
Mailing Address - Street 1:5300 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1903
Mailing Address - Country:US
Mailing Address - Phone:716-298-2081
Mailing Address - Fax:716-298-2112
Practice Address - Street 1:5300 MILITARY RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1903
Practice Address - Country:US
Practice Address - Phone:716-298-2081
Practice Address - Fax:716-298-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3121001H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH4OtherINDEPENDENT HEALTH
NY000000022000OtherBLUE CROSS
NY00011413101OtherUNIVERA - EXCELLUS
NY01746616Medicaid
NY72000AMedicare ID - Type UnspecifiedMEDICARE PART B
NY330188Medicare Oscar/Certification