Provider Demographics
NPI:1659360709
Name:BON SECOURS COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:BON SECOURS COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-368-5000
Mailing Address - Street 1:160 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-2253
Mailing Address - Country:US
Mailing Address - Phone:845-858-7000
Mailing Address - Fax:845-858-7415
Practice Address - Street 1:160 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2253
Practice Address - Country:US
Practice Address - Phone:845-858-7000
Practice Address - Fax:845-858-7415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000155OtherBLUE CROSS
NY4154304Medicaid
NYUS HEALTCAREOther0012335
NY000000084602OtherTHREE RIVERS
NY0004836000OtherAMERIHEALTH
NY00273905Medicaid
NY4569OtherWELLCARE
NY928114OtherMVP
NYH384535OtherOXFORD
NY000000043822OtherGHI HMO
NY1007778760003Medicaid
NYIC0507OtherHEALTHNET
NYIC508OtherPHS
NY5000031OtherUNITED HEALTHCARE COMPLET
NY811968OtherFIRST PRIORITY HEALTH
NYUS HEALTCAREOther0012335
NY330135Medicare Oscar/Certification