Provider Demographics
NPI:1982625661
Name:NICHOLAS H. NOYES MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:NICHOLAS H. NOYES MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUNOSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-335-6001
Mailing Address - Street 1:111 CLARA BARTON ST
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-9503
Mailing Address - Country:US
Mailing Address - Phone:585-335-6001
Mailing Address - Fax:585-335-2769
Practice Address - Street 1:111 CLARA BARTON ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437
Practice Address - Country:US
Practice Address - Phone:585-335-6001
Practice Address - Fax:585-335-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2527000H261QM0801X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000068000OtherBLUE CROSS OF WESTERN NY
NY068OtherCOMMUNITY SENIOR BLUE
NY08SOtherEXCELLUS OF ROCHESTER
NY1030788DOtherCOMMUNITY BLUE
PA0014060920001Medicaid
NY100002CFOtherCOMMUNITY BLUE
NY100002CCFOtherCOMMUNITY BLUE
NY000011000010OtherFIDELIS CARE NY
NY00354476Medicaid
NY014006208SOtherEXCELLUS OF ROCHESTER
NY08OtherEXCELLUS OF ROCHESTER NY
NY01206208OtherFAMILY FIRST
NJ4159900OtherNEW JERSEY MEDICAID
NY6450545OtherAETNA
NY010046248OtherEXCELLUS OF ROCHESTER
NY08OtherEXCELLUS OF ROCHESTER
FL095777100OtherFLORIDA MEDICAID
NY70009AMedicare ID - Type Unspecified
NJ4159900OtherNEW JERSEY MEDICAID