Provider Demographics
NPI:1477667145
Name:BELLEVUE WOMAN'S MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:BELLEVUE WOMAN'S MEDICAL CENTER, INC.
Other - Org Name:BELLEVUE WOMAN'S HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUSKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-346-9411
Mailing Address - Street 1:2210 TROY ROAD
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-4797
Mailing Address - Country:US
Mailing Address - Phone:518-346-9400
Mailing Address - Fax:518-346-9416
Practice Address - Street 1:2210 TROY ROAD
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-4797
Practice Address - Country:US
Practice Address - Phone:518-346-9400
Practice Address - Fax:518-346-9416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4652001H282NW0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NW0100XHospitalsGeneral Acute Care HospitalWomen
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000400031002OtherBLUE SHIELD
NY000931OtherBLUE CROSS
NY0103OtherMVP
NY00354132Medicaid
NY10005735OtherCDPHP
NY330339Medicare ID - Type Unspecified