Provider Demographics
NPI:1508815333
Name:ST JOSEPHS HOSPITAL HEALTH CENTER
Entity Type:Organization
Organization Name:ST JOSEPHS HOSPITAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-448-5880
Mailing Address - Street 1:301 PROSPECT AVE
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1807
Mailing Address - Country:US
Mailing Address - Phone:315-448-5880
Mailing Address - Fax:315-448-6161
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:ADMINISTRATION
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-5880
Practice Address - Fax:315-448-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02995893Medicaid
NY02995893Medicaid