Provider Demographics
NPI:1730139536
Name:KALEIDA HEALTH
Entity Type:Organization
Organization Name:KALEIDA HEALTH
Other - Org Name:WCHOB RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-859-8385
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT. 413
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:716-692-2160
Mailing Address - Fax:716-213-0348
Practice Address - Street 1:219 BRYANT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2006
Practice Address - Country:US
Practice Address - Phone:716-878-7000
Practice Address - Fax:716-213-0348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01649710Medicaid
NYAA1242Medicare PIN