Provider Demographics
NPI:1235749979
Name:LEWIS COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:LEWIS COUNTY GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-376-5246
Mailing Address - Street 1:LEWIS COUNTY GENERAL HOSPITAL
Mailing Address - Street 2:7785N STATE ST
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367
Mailing Address - Country:US
Mailing Address - Phone:315-376-5246
Mailing Address - Fax:315-376-9317
Practice Address - Street 1:COPENHAGEN HEALTH CENTER
Practice Address - Street 2:9732 STATE ROUTE 12
Practice Address - City:COPENHAGEN
Practice Address - State:NY
Practice Address - Zip Code:13626-1362
Practice Address - Country:US
Practice Address - Phone:315-688-2305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03304574Medicaid