Provider Demographics
NPI:1922135367
Name:ADIRONDACK MEDICAL CENTER
Entity Type:Organization
Organization Name:ADIRONDACK MEDICAL CENTER
Other - Org Name:ADIRONDACK MEDICAL CENTER - SL DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PFS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:STRATFORD
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:518-897-2636
Mailing Address - Street 1:2233 STATE ROUTE 86
Mailing Address - Street 2:RENAL DIALYSIS CENTER
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-5644
Mailing Address - Country:US
Mailing Address - Phone:518-897-2641
Mailing Address - Fax:518-897-2642
Practice Address - Street 1:2233 STATE ROUTE 86
Practice Address - Street 2:RENAL DIALYSIS CENTER
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5644
Practice Address - Country:US
Practice Address - Phone:518-897-2641
Practice Address - Fax:518-897-2642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1623001H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00363213Medicaid
NY=========OtherTAX ID
NY00363213Medicaid