Provider Demographics
NPI:1801229216
Name:CANTON-POTSDAM HOSPITAL
Entity Type:Organization
Organization Name:CANTON-POTSDAM HOSPITAL
Other - Org Name:CPH EMERGENCY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-261-5100
Mailing Address - Street 1:1116 ARSENAL STREET
Mailing Address - Street 2:SUITE 504
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-6120
Mailing Address - Country:US
Mailing Address - Phone:315-782-2620
Mailing Address - Fax:315-788-4980
Practice Address - Street 1:50 LEROY ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1786
Practice Address - Country:US
Practice Address - Phone:315-261-5910
Practice Address - Fax:315-261-6410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANTON-POTSDAM HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty