Provider Demographics
NPI:1760800635
Name:GLENS FALLS HOSPITAL INC.
Entity Type:Organization
Organization Name:GLENS FALLS HOSPITAL INC.
Other - Org Name:EMERGENCY CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:SVP FINANCE AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:AMADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-926-5113
Mailing Address - Street 1:100 PARK ST
Mailing Address - Street 2:EMERGENCY CARE CENTER
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-6992
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:100 PARK ST
Practice Address - Street 2:EMERGENCY CARE CENTER
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4413
Practice Address - Country:US
Practice Address - Phone:518-926-6992
Practice Address - Fax:518-926-6983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLENS FALLS HOSPITAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-28
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70021AOtherMEDICARE PART B
NY70021AOtherMEDICARE PART B