Provider Demographics
NPI:1457519589
Name:FREDERICK FERRIS THOMPSON HOSPITAL
Entity Type:Organization
Organization Name:FREDERICK FERRIS THOMPSON HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-396-6000
Mailing Address - Street 1:350 PARRISH STREET
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1731
Mailing Address - Country:US
Mailing Address - Phone:585-396-6000
Mailing Address - Fax:
Practice Address - Street 1:350 PARRISH STREET
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1731
Practice Address - Country:US
Practice Address - Phone:585-396-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREDERICK FERRIS THOMPSON HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-27
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3429000H207P00000X
261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY107060AZOtherPREFERRED CARE ED PHYSICIANS
107060AZOtherMVP HEALTHCARE ED PHYSICIANS