Provider Demographics
NPI:1376546440
Name:ROME MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:ROME MEMORIAL HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
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 1:1500 N JAMES ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2844
Practice Address - Country:US
Practice Address - Phone:315-337-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03001434Medicaid
NY0009OtherHMOBLUE
NY0392OtherMVP
NM10023563OtherCDPHP
NY352534Medicaid
NY0392OtherMVP
NY0392OtherMVP
NY70070AMedicare ID - Type UnspecifiedBINGHAMTON