Provider Demographics
NPI:1558490201
Name:FREDERICK FERRIS THOMPSON HOSPITAL
Entity Type:Organization
Organization Name:FREDERICK FERRIS THOMPSON HOSPITAL
Other - Org Name:THOMPSON HEALTH FAMILY PRACTICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-396-6000
Mailing Address - Street 1:350 PARRISH ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1731
Mailing Address - Country:US
Mailing Address - Phone:585-396-6865
Mailing Address - Fax:585-396-6455
Practice Address - Street 1:360 PARRISH ST
Practice Address - Street 2:BOX 15
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1777
Practice Address - Country:US
Practice Address - Phone:585-396-6505
Practice Address - Fax:585-396-6455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00362529Medicaid
NY330074Medicare Oscar/Certification
NY00362529Medicaid
NY81113AMedicare ID - Type UnspecifiedCCC PROVIDER NUMBER