Provider Demographics
NPI:1366473183
Name:KALEIDA HEALTH
Entity Type:Organization
Organization Name:KALEIDA HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRENTIALING AR RECEIVABLES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-859-8396
Mailing Address - Street 1:100 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1126
Mailing Address - Country:US
Mailing Address - Phone:716-859-1993
Mailing Address - Fax:
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-859-1993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1401014H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00360614Medicaid
NY00384643Medicaid
NY00361968Medicaid
NY33T005Medicare Oscar/Certification
NY332408Medicare Oscar/Certification
NY33S005Medicare Oscar/Certification
NY330005Medicare Oscar/Certification
NY00360614Medicaid
NY7000AAMedicare PIN