Provider Demographics
NPI:1053656744
Name:ELIZABETHTOWN COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:ELIZABETHTOWN COMMUNITY HOSPITAL
Other - Org Name:ECH PHYSICIAN'S GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-873-9000
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12932-0277
Mailing Address - Country:US
Mailing Address - Phone:518-873-9000
Mailing Address - Fax:518-873-3097
Practice Address - Street 1:75 PARK STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NY
Practice Address - Zip Code:12932
Practice Address - Country:US
Practice Address - Phone:518-873-9000
Practice Address - Fax:518-873-3097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1552701C208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty