Provider Demographics
NPI:1053441907
Name:KALEIDA HEALTH
Entity Type:Organization
Organization Name:KALEIDA HEALTH
Other - Org Name:MILLARD FILLMORE SUBURBAN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCCROREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-859-8313
Mailing Address - Street 1:726 EXCHANGE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14210-1467
Mailing Address - Country:US
Mailing Address - Phone:716-859-8396
Mailing Address - Fax:
Practice Address - Street 1:1540 MAPLE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3647
Practice Address - Country:US
Practice Address - Phone:716-568-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KALEIDA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-07
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00384643Medicaid
NY7000AAMedicare PIN
NY00384643Medicaid