Provider Demographics
NPI:1275292633
Name:CHENANGO MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:CHENANGO MEMORIAL HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DRAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-337-4113
Mailing Address - Street 1:179 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1019
Mailing Address - Country:US
Mailing Address - Phone:607-337-4111
Mailing Address - Fax:607-337-4284
Practice Address - Street 1:179 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1019
Practice Address - Country:US
Practice Address - Phone:607-337-4111
Practice Address - Fax:607-337-4284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0824000HOtherOPER CERT#
NY330033OtherMEDICARE PTAN