Provider Demographics
NPI:1215044516
Name:SOLDIERS & SAILORS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SOLDIERS & SAILORS MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER/CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-787-4031
Mailing Address - Street 1:418 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1085
Mailing Address - Country:US
Mailing Address - Phone:315-787-4150
Mailing Address - Fax:315-787-4794
Practice Address - Street 1:418 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1085
Practice Address - Country:US
Practice Address - Phone:315-787-4150
Practice Address - Fax:315-787-4794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYEIN146L00000X
282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17OtherBLUE CROSS ACUTE
NY012005017OtherBLUE CHOICE INPATIENT
NY014005017OtherBLUE CHOICE OUTPATIENT
NY00336498Medicaid
NY10018CFOtherPREFERRED CARE ACUTE
NY331314Medicare Oscar/Certification