Healthcare Provider Details

I. General information

NPI: 1659310605
Provider Name (Legal Business Name): MERCY HOSPITAL OF BUFFALO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 ABBOTT RD
BUFFALO NY
14220-2039
US

IV. Provider business mailing address

565 ABBOTT RD
BUFFALO NY
14220-2039
US

V. Phone/Fax

Practice location:
  • Phone: 716-826-7000
  • Fax:
Mailing address:
  • Phone: 716-826-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number1401008H
License Number StateNY

VIII. Authorized Official

Name: CHARLES J URLAUB
Title or Position: CEO
Credential:
Phone: 716-828-2008