Provider Demographics
NPI:1083607915
Name:MOSES-LUDINGTON HOSPITAL
Entity Type:Organization
Organization Name:MOSES-LUDINGTON HOSPITAL
Other - Org Name:INTER-LAKES HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUGHNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-585-3719
Mailing Address - Street 1:1019 WICKER ST
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-1039
Mailing Address - Country:US
Mailing Address - Phone:518-585-3700
Mailing Address - Fax:518-585-2576
Practice Address - Street 1:1019 WICKER ST
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883
Practice Address - Country:US
Practice Address - Phone:518-585-3700
Practice Address - Fax:518-585-2576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1564701C282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000932OtherEMPIRE BLUE CROSS
NY00360930Medicaid
NY330116OtherEXCELLUS BLUE CROSS
NY000400017000OtherBLUESHIELD OF NENY
NY33Z306Medicare Oscar/Certification
NY000932OtherEMPIRE BLUE CROSS
NY331306Medicare Oscar/Certification