Provider Demographics
NPI:1770598104
Name:KENMORE MERCY HOSPITAL
Entity type:Organization
Organization Name:KENMORE MERCY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNLOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-862-2431
Mailing Address - Street 1:2950 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1304
Mailing Address - Country:US
Mailing Address - Phone:716-447-6100
Mailing Address - Fax:
Practice Address - Street 1:2950 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1304
Practice Address - Country:US
Practice Address - Phone:716-447-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040401000067OtherFIDELIS
NY041OtherBLUE CROSS OF WNY
NY00354343Medicaid
NY00011412501OtherUNIVERA
NY10OtherINDEPENDENT HEALTH
NY330102Medicare Oscar/Certification
NY00354343Medicaid