Provider Demographics
NPI:1255360517
Name:ROCHESTER GENERAL HOSPITAL
Entity type:Organization
Organization Name:ROCHESTER GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP- FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:TINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-1223
Mailing Address - Street 1:1425 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3001
Mailing Address - Country:US
Mailing Address - Phone:585-922-4000
Mailing Address - Fax:
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-922-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X, 261QR0405X, 261QM0801X
NY2701003H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012005914OtherBLUE CHOICE IP
NYFA01916OtherPREFERRED CARE ED GROUP
NY01131126Medicaid
NYC15370OtherRAILROAD MEDICARE
NY014005914OtherBLUE CHOICE OP
NY00303315Medicaid
NY012005914OtherBLUE CHOICE IP
NYC15370OtherRAILROAD MEDICARE
NY330125001Medicare Oscar/Certification
NYBA1382Medicare PIN