Healthcare Provider Details

I. General information

NPI: 1528279817
Provider Name (Legal Business Name): CARTHAGE AREA HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N MECHANIC ST
CARTHAGE NY
13619-1252
US

IV. Provider business mailing address

1001 WEST ST
CARTHAGE NY
13619-9703
US

V. Phone/Fax

Practice location:
  • Phone: 315-493-3100
  • Fax: 315-493-3113
Mailing address:
  • Phone: 315-519-5724
  • Fax: 315-493-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2238001H
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number2238001H
License Number StateNY

VIII. Authorized Official

Name: RICHARD DUVALL
Title or Position: CEO ADMINISTRATOR
Credential:
Phone: 315-519-5201