Provider Demographics
NPI:1245360718
Name:MOSES LUDINGTON HOSPITAL
Entity type:Organization
Organization Name:MOSES LUDINGTON HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-585-3784
Mailing Address - Street 1:1019 WICKER ST
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-1039
Mailing Address - Country:US
Mailing Address - Phone:518-585-3855
Mailing Address - Fax:518-585-3808
Practice Address - Street 1:1019 WICKER ST
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-1039
Practice Address - Country:US
Practice Address - Phone:518-585-3855
Practice Address - Fax:518-585-3808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOSES LUDINGTON HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-06
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9175850OtherFIDELIS CARE NY
NY02225730Medicaid