Healthcare Provider Details

I. General information

NPI: 1346500113
Provider Name (Legal Business Name): ST. MARY'S HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 ERIE BLVD
CANAJOHARIE NY
13317
US

IV. Provider business mailing address

380 GUY PARK AVE
AMSTERDAM NY
12010
US

V. Phone/Fax

Practice location:
  • Phone: 518-673-2573
  • Fax: 518-673-2781
Mailing address:
  • Phone: 518-841-7430
  • Fax: 518-841-7121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number158811
License Number StateNY

VIII. Authorized Official

Name: NANCY COLLINS
Title or Position: DIRECTOR, PRIMARY CARE
Credential:
Phone: 518-841-7407