Provider Demographics
NPI:1356441349
Name:ALICE HYDE MEDICAL CENTER
Entity type:Organization
Organization Name:ALICE HYDE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-481-2212
Mailing Address - Street 1:133 PARK ST
Mailing Address - Street 2:PO BOX 729
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1220
Mailing Address - Country:US
Mailing Address - Phone:518-483-3000
Mailing Address - Fax:518-481-2662
Practice Address - Street 1:133 PARK ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1220
Practice Address - Country:US
Practice Address - Phone:518-483-3000
Practice Address - Fax:518-481-2662
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALICE HYDE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1624000N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1624000NMedicaid
NY1624000NMedicaid