Provider Demographics
NPI:1326473646
Name:ST. MARY'S HEALTHCARE
Entity Type:Organization
Organization Name:ST. MARY'S HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS ENROLLMENT CRED. SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-770-7518
Mailing Address - Street 1:427 GUY PARK AVE
Mailing Address - Street 2:CORPORATE RESPONSIBILITY LEGAL DEPT.
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1054
Mailing Address - Country:US
Mailing Address - Phone:518-770-7518
Mailing Address - Fax:518-770-7570
Practice Address - Street 1:427 GUY PARK AVE
Practice Address - Street 2:CORPORATE RESPONSIBILITY LEGAL DEPT.
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1054
Practice Address - Country:US
Practice Address - Phone:518-770-7518
Practice Address - Fax:518-770-7570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02176332Medicaid
NY02176332Medicaid