Provider Demographics
NPI:1821093402
Name:ST ELIZABETH MEDICAL CENTER
Entity Type:Organization
Organization Name:ST ELIZABETH MEDICAL CENTER
Other - Org Name:MOHAWK VALLEY HEALTH SYSTEM INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-801-4238
Mailing Address - Street 1:2209 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5999
Mailing Address - Country:US
Mailing Address - Phone:315-801-4238
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:2209 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5930
Practice Address - Country:US
Practice Address - Phone:315-798-8100
Practice Address - Fax:315-798-8391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3202002H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00892975Medicaid
NY002799001Medicaid
NY330245Medicare Oscar/Certification
NY00892975Medicaid