Provider Demographics
NPI:1699371013
Name:COMMUNITY MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, BUSINESS
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-824-6560
Mailing Address - Street 1:150 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-9575
Mailing Address - Country:US
Mailing Address - Phone:315-824-7088
Mailing Address - Fax:315-648-6413
Practice Address - Street 1:5180 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MUNNSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13409-4058
Practice Address - Country:US
Practice Address - Phone:315-495-2690
Practice Address - Fax:315-495-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty