Provider Demographics
NPI:1891753034
Name:CLAXTON-HEPBURN MEDICAL CENTER
Entity Type:Organization
Organization Name:CLAXTON-HEPBURN MEDICAL CENTER
Other - Org Name:PRACTICE RESOURCES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, REVENUE CYCLE OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-713-5354
Mailing Address - Street 1:214 KING ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-1142
Mailing Address - Country:US
Mailing Address - Phone:315-393-3600
Mailing Address - Fax:315-393-7250
Practice Address - Street 1:214 KING ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-1142
Practice Address - Country:US
Practice Address - Phone:315-393-3600
Practice Address - Fax:315-393-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4401000H282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354072Medicaid
NY00577775Medicaid
NY01293952Medicaid
NYCA0549OtherRAILROAD MEDICARE
NY01293952Medicaid
NYCA0549OtherRAILROAD MEDICARE
NY70065AMedicare PIN