Provider Demographics
NPI:1295899086
Name:SOUTHAMPTON HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:SOUTHAMPTON HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHULTHEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-726-8300
Mailing Address - Street 1:147 BEACH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-1733
Mailing Address - Country:US
Mailing Address - Phone:631-288-7746
Mailing Address - Fax:631-288-7111
Practice Address - Street 1:147 BEACH RD
Practice Address - Street 2:SUITE A
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-1733
Practice Address - Country:US
Practice Address - Phone:631-288-7746
Practice Address - Fax:631-288-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPFI #5757261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02548492Medicaid
W7D131Medicare PIN