Provider Demographics
NPI:1215194501
Name:GENEVA GENERAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:GENEVA GENERAL HOSPITAL, INC.
Other - Org Name:GENEVA GENERAL HOSPITAL PHYSICIAN PRACTICES
Other - Org Type:Doing Business As
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:315-787-4030
Mailing Address - Street 1:196 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1651
Mailing Address - Country:US
Mailing Address - Phone:315-787-4150
Mailing Address - Fax:315-787-4794
Practice Address - Street 1:196 NORTH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1651
Practice Address - Country:US
Practice Address - Phone:315-787-4150
Practice Address - Fax:315-787-4794
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENEVA GENERAL HOSPITAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-22
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00378712Medicaid
NY00378712Medicaid