Provider Demographics
NPI:1114954682
Name:ALICE HYDE MEDICAL CENTER
Entity Type:Organization
Organization Name:ALICE HYDE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-481-2847
Mailing Address - Street 1:133 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1220
Mailing Address - Country:US
Mailing Address - Phone:518-481-2210
Mailing Address - Fax:518-481-2818
Practice Address - Street 1:133 PARK ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1220
Practice Address - Country:US
Practice Address - Phone:518-481-2210
Practice Address - Fax:518-481-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
NY1624000H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354114Medicaid
NY330084Medicare Oscar/Certification