Provider Demographics
NPI:1518926401
Name:ST MARYS HEALTHCARE
Entity Type:Organization
Organization Name:ST MARYS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PRIMARY & SPECIALTY CARE
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BSC,MSIHCM
Authorized Official - Phone:518-841-7407
Mailing Address - Street 1:427 GUY PARK AVE
Mailing Address - Street 2:ST MARYS HEALTHCARE -PRIMARY&SPECIALTY CARE
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1054
Mailing Address - Country:US
Mailing Address - Phone:518-841-7407
Mailing Address - Fax:518-841-7121
Practice Address - Street 1:427 GUY PARK AVE
Practice Address - Street 2:ST MARYS HEALTHCARE PRIMARY CARE DEPT
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1054
Practice Address - Country:US
Practice Address - Phone:518-841-7407
Practice Address - Fax:518-841-7121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02176332Medicaid
NY70033AMedicare PIN