MEDICARE: ST. JAMES HOSPITAL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	207R00000X	Internal Medicine Physician
3	207RC0000X	Cardiovascular Disease Physician
4	207RP1001X	Pulmonary Disease Physician
5	207V00000X	Obstetrics & Gynecology Physician
6	207X00000X	Orthopaedic Surgery Physician
7	208000000X	Pediatrics Physician
8	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0075639	OTHER	NY	GHI GROUP #
3	=========	OTHER	NY	TRICARE GROUP #

General Provider Information

NPI Number	:	1699839431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JAMES HOSPITAL

Provider Business Mailing Address
First Line	:	411 CANISTEO ST
Second Line	:	3RD FLOOR LINCOLN SCHOOL
City	:	HORNELL
State	:	NY
Zip	:	14843-2104
Country	:	US
Telephone Number	:	607-324-8294
Fax Number	:	607-324-8766

Provider Business Practice Location Address
First Line	:	7329 SENECA ROAD NORTH
Second Line	:
City	:	HORNELL
State	:	NY
Zip	:	14843
Country	:	US
Telephone Number	:	607-385-3960
Fax Number	:	607-385-3195

Authorized Official
Title or Position	:	PHYSICIAN STAFF COORDINATOR
Name	:	STEPHANIE MITCHELL
Credential	:
Telephone Number	:	607-324-8294

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	05/07/2020

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Directions to “ST. JAMES HOSPITAL ” Practice Location

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