Provider Demographics
NPI:1356689004
Name:ROME MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:ROME MEMORIAL HOSPITAL, INC
Other - Org Name:REGIONAL WOUND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CZYZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-337-1200
Mailing Address - Street 1:1500 N JAMES ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2844
Mailing Address - Country:US
Mailing Address - Phone:315-337-1200
Mailing Address - Fax:
Practice Address - Street 1:267 AVERY LN STE 200
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13441-4240
Practice Address - Country:US
Practice Address - Phone:315-338-7540
Practice Address - Fax:315-338-7538
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROME MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-30
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03974265Medicaid