Provider Demographics
NPI:1649947649
Name:OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BROOKSMCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-584-5474
Mailing Address - Street 1:169 RIVERSIDE DRIVE
Mailing Address - Street 2:CREDENTIALING DEPT @ LBC
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905
Mailing Address - Country:US
Mailing Address - Phone:607-584-5474
Mailing Address - Fax:607-584-5521
Practice Address - Street 1:184 COURT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-3515
Practice Address - Country:US
Practice Address - Phone:607-584-4465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-26
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)