Provider Demographics
NPI:1043455199
Name:SISTERS OF CHARITY HOSPITAL
Entity Type:Organization
Organization Name:SISTERS OF CHARITY HOSPITAL
Other - Org Name:ST. JOSEPH CAMPUS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:V
Authorized Official - Last Name:BERGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-862-1900
Mailing Address - Street 1:2157 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2648
Mailing Address - Country:US
Mailing Address - Phone:716-862-1000
Mailing Address - Fax:
Practice Address - Street 1:2605 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4018
Practice Address - Country:US
Practice Address - Phone:716-891-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SISTERS OF CHARITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-03
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1401013H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY24OtherIHA
NY0000000005000OtherBLUE CROSS HEALTH NOW
NY0011413501OtherUNIVERA
NY040401000066OtherFIDELIS
NY330078Medicaid
NY0011413501OtherUNIVERA
NY330078Medicare UPIN