Provider Demographics
NPI:1790857308
Name:LEWIS COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:LEWIS COUNTY GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-376-5226
Mailing Address - Street 1:PO BOX 2337
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13220-2337
Mailing Address - Country:US
Mailing Address - Phone:315-701-5610
Mailing Address - Fax:
Practice Address - Street 1:9559 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:NY
Practice Address - Zip Code:13305
Practice Address - Country:US
Practice Address - Phone:315-346-6824
Practice Address - Fax:315-346-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02848213Medicaid
NY54458AMedicare PIN
NY02848213Medicaid