Provider Demographics
NPI:1891785184
Name:ELIZABETHTOWN COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:ELIZABETHTOWN COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-873-6377
Mailing Address - Street 1:75 PARK ST
Mailing Address - Street 2:PO BOX 277
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12932-0277
Mailing Address - Country:US
Mailing Address - Phone:518-873-6377
Mailing Address - Fax:518-873-2315
Practice Address - Street 1:75 PARK ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NY
Practice Address - Zip Code:12932-2300
Practice Address - Country:US
Practice Address - Phone:518-873-6377
Practice Address - Fax:518-873-2315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354274Medicaid
NY331302Medicare Oscar/Certification
NY70037AMedicare PIN