Provider Demographics
NPI:1487183174
Name:ADIRONDACK MEDICAL CENTER
Entity Type:Organization
Organization Name:ADIRONDACK MEDICAL CENTER
Other - Org Name:ADIRONDACK MEDICAL CENTER-HOSPITALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADELE
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKREIGN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-897-4725
Mailing Address - Street 1:PO BOX 1380
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-7380
Mailing Address - Country:US
Mailing Address - Phone:518-897-2479
Mailing Address - Fax:518-897-2530
Practice Address - Street 1:2233 STATE ROUTE 86
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5644
Practice Address - Country:US
Practice Address - Phone:518-897-2479
Practice Address - Fax:518-897-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00363213Medicaid