Provider Demographics
NPI:1083655492
Name:KENMORE MERCY HOSPITAL
Entity Type:Organization
Organization Name:KENMORE MERCY HOSPITAL
Other - Org Name:KENMORE SPECIALTY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PRIMARY CARE CENTERS
Authorized Official - Prefix:
Authorized Official - First Name:CECELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-447-6454
Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:STE. 208
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-2160
Mailing Address - Fax:716-692-4342
Practice Address - Street 1:2950 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1304
Practice Address - Country:US
Practice Address - Phone:716-447-6100
Practice Address - Fax:716-692-4342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA1086Medicare PIN