Provider Demographics
NPI:1275553521
Name:BERTRAND CHAFFEE HOSPITAL
Entity Type:Organization
Organization Name:BERTRAND CHAFFEE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HEBDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:716-592-9643
Mailing Address - Street 1:224 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-1443
Mailing Address - Country:US
Mailing Address - Phone:716-592-2871
Mailing Address - Fax:716-592-8113
Practice Address - Street 1:224 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1443
Practice Address - Country:US
Practice Address - Phone:716-592-2871
Practice Address - Fax:716-592-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1427000H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354150Medicaid
NY000000040000OtherBLUE CROSS OF WESTERN NY
330111Medicare ID - Type Unspecified