Provider Demographics
NPI:1497961205
Name:ERIE COUNTY MEDICAL CENTER CORPORATION
Entity Type:Organization
Organization Name:ERIE COUNTY MEDICAL CENTER CORPORATION
Other - Org Name:IP HEAD TRAUMA
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-898-5931
Mailing Address - Street 1:462 GRIDER ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-898-5931
Mailing Address - Fax:716-898-5178
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-5931
Practice Address - Fax:716-898-5178
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERIE COUNTY MEDICAL CENTER CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-16
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1401005H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245863Medicaid
NY000000042007OtherBC HEAD TRAUMA
NY11412205OtherUNIVERA
NY7TOtherIHA IP HEAD TRAUMA
NY000000042007OtherBC HEAD TRAUMA