Provider Demographics
NPI:1689369696
Name:ALICE HYDE MEDICAL CENTER
Entity Type:Organization
Organization Name:ALICE HYDE MEDICAL CENTER
Other - Org Name:THE UNIVERSITY OF VERMONT HEALTH NETWORK-ALICE HYDE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-481-2410
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-0429
Mailing Address - Country:US
Mailing Address - Phone:518-481-2458
Mailing Address - Fax:518-481-2818
Practice Address - Street 1:133 PARK ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1244
Practice Address - Country:US
Practice Address - Phone:518-481-2458
Practice Address - Fax:518-481-2818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit