MEDICARE: GLENS FALLS HOSPITAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1023365541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENS FALLS HOSPITAL INC

Provider Business Mailing Address
First Line	:	100 PARK STREET
Second Line	:	GLENS FALLS HOSPITAL - CREDENTIALING
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-4413
Country	:	US
Telephone Number	:	518-926-5924
Fax Number	:	518-926-6983

Provider Business Practice Location Address
First Line	:	325 MAIN ST
Second Line	:
City	:	HUDSON FALLS
State	:	NY
Zip	:	12839-1512
Country	:	US
Telephone Number	:	518-747-3376
Fax Number	:	518-747-8745

Authorized Official
Title or Position	:	INTERIM PRESIDENT/CEO
Name	:	PAUL SCIMECA
Credential	:
Telephone Number	:	518-926-5902

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	04/02/2024

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