Provider Demographics
NPI:1750480604
Name:UNITED HEALTH SERVICES HOSPITALS INC
Entity Type:Organization
Organization Name:UNITED HEALTH SERVICES HOSPITALS INC
Other - Org Name:UNITED MEDMANAGEMENT INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER OF PHARMACY SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MHA
Authorized Official - Phone:607-763-1869
Mailing Address - Street 1:1302 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5430
Mailing Address - Country:US
Mailing Address - Phone:607-754-2474
Mailing Address - Fax:607-754-3384
Practice Address - Street 1:1302 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5430
Practice Address - Country:US
Practice Address - Phone:607-754-2474
Practice Address - Fax:607-754-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0293453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY029345OtherNYS LICENSE #
NY03104390Medicaid
FU1439389OtherDEA #