Provider Demographics
NPI:1932182599
Name:HEALTHALLIANCE HOSPITAL MARYS AVENUE CAMPUS
Entity Type:Organization
Organization Name:HEALTHALLIANCE HOSPITAL MARYS AVENUE CAMPUS
Other - Org Name:BENEDICTINE HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AVP, REVENUE CYCLE
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-493-2961
Mailing Address - Street 1:105 MARYS AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5829
Mailing Address - Country:US
Mailing Address - Phone:845-943-6007
Mailing Address - Fax:845-943-6038
Practice Address - Street 1:105 MARYS AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5829
Practice Address - Country:US
Practice Address - Phone:845-943-6007
Practice Address - Fax:845-943-6308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03000199Medicaid
NYUV5282OtherMVP HEALTH PLAN ID
NY000302OtherBLUE CROSS PROVIDER NUMBE
NY10005742OtherCDPHP PROVIDER ID
NY103185OtherWELLCARE PROVIDER ID
NY6450795OtherAETNA PROVIDER ID
NY3185OtherGHI PROVIDER ID
NY103185OtherWELLCARE PROVIDER ID