Provider Demographics
NPI:1316016447
Name:MOSES-LUDINGTON HOSPITAL
Entity Type:Organization
Organization Name:MOSES-LUDINGTON HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-585-3720
Mailing Address - Street 1:1019 WICKER ST
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-1039
Mailing Address - Country:US
Mailing Address - Phone:518-585-3700
Mailing Address - Fax:518-585-3899
Practice Address - Street 1:1019 WICKER ST
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883
Practice Address - Country:US
Practice Address - Phone:518-585-3700
Practice Address - Fax:518-585-3899
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOSES LUDINGTON HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-06
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1564701C275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000400017000OtherBLUESHIELD NENY
NY03002375Medicaid
NY000932OtherBLUE CROSS
NY00360930Medicaid
NY330116OtherEXCELLUS BLUE CROSS
NY00360930Medicaid
NY000400017000OtherBLUESHIELD NENY
NY330116OtherEXCELLUS BLUE CROSS
NY70039AMedicare PIN