Provider Demographics
NPI:1891113965
Name:ROME MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:ROME MEMORIAL HOSPITAL, INC
Other - Org Name:CAMDEN FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CZYZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-337-1200
Mailing Address - Street 1:245 AVERY LN
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13441-4237
Mailing Address - Country:US
Mailing Address - Phone:315-337-1200
Mailing Address - Fax:
Practice Address - Street 1:5 MASONIC AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13316-1234
Practice Address - Country:US
Practice Address - Phone:315-245-3192
Practice Address - Fax:315-245-3195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROME MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-04
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04235030Medicaid
NY03001434Medicaid