Healthcare Provider Details

I. General information

NPI: 1306930318
Provider Name (Legal Business Name): IRA DAVENPORT MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7571 STATE ROUTE 54
BATH NY
14810-9504
US

IV. Provider business mailing address

7571 STATE ROUTE 54
BATH NY
14810
US

V. Phone/Fax

Practice location:
  • Phone: 607-776-8500
  • Fax: 607-776-8800
Mailing address:
  • Phone: 607-776-8500
  • Fax: 607-776-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN I. LAWRENCE
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 607-776-8500