Provider Demographics
NPI:1659411106
Name:GUTHRIE CORTLAND MEDICAL CENTER
Entity Type:Organization
Organization Name:GUTHRIE CORTLAND MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:WRINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-756-3526
Mailing Address - Street 1:PO BOX 2060
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-0946
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:134 HOMER AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1206
Practice Address - Country:US
Practice Address - Phone:607-756-3554
Practice Address - Fax:607-756-3545
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUTHRIE CORTLAND MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-07
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3336I0012X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00279176Medicaid
NY00279176Medicaid