Provider Demographics
NPI:1336497387
Name:GLENS FALLS HOSPITAL INC
Entity Type:Organization
Organization Name:GLENS FALLS HOSPITAL INC
Other - Org Name:GREENWICH REGIONAL MEDICAL CENTER SPECIALTY SUITE
Other - Org Type:Other Name
Authorized Official - Title/Position:INTERIM PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCIMECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-926-5902
Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:1134 STATE ROUTE 29
Practice Address - Street 2:GREENWICH REGIONAL MEDICAL CENTER SPECIALTY SUITE
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834-6107
Practice Address - Country:US
Practice Address - Phone:518-692-9635
Practice Address - Fax:518-692-7586
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLENS FALLS HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-23
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty