Provider Demographics
NPI:1356656045
Name:ADIRONDACK MEDICAL CENTER
Entity Type:Organization
Organization Name:ADIRONDACK MEDICAL CENTER
Other - Org Name:ADIRONDACK MEDICAL CENTER DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PFS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:STRATFORD
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:518-897-2636
Mailing Address - Street 1:114 WAWBEEK AVE
Mailing Address - Street 2:
Mailing Address - City:TUPPER LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12986-2038
Mailing Address - Country:US
Mailing Address - Phone:518-359-4900
Mailing Address - Fax:518-891-5097
Practice Address - Street 1:114 WAWBEEK AVE
Practice Address - Street 2:
Practice Address - City:TUPPER LAKE
Practice Address - State:NY
Practice Address - Zip Code:12986-2038
Practice Address - Country:US
Practice Address - Phone:518-359-4900
Practice Address - Fax:518-891-5097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1623001H261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33-3564OtherMEDICARE CCN
NY33-3564OtherMEDICARE CCN