Provider Demographics
NPI:1164436283
Name:KENMORE MERCY HOSPITAL
Entity Type:Organization
Organization Name:KENMORE MERCY HOSPITAL
Other - Org Name:KENMORE MERCY HOSPITAL REHABILITATION UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR VICE PRESIDENT FINANCE & CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNLOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-862-2431
Mailing Address - Street 1:2950 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1304
Mailing Address - Country:US
Mailing Address - Phone:716-447-6100
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENMORE MERCY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1404030H273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011412501OtherUNIVERA
NY00354343Medicaid
NY041OtherBLUE CROSS OF WNY
NY10OtherINDEPENDENT HEALTH
NY040401000067OtherFIDELIS
NY00011412501OtherUNIVERA
NY00354343Medicaid