Healthcare Provider Details

I. General information

NPI: 1457050429
Provider Name (Legal Business Name): COLUMBIA MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 JEFFERSON HTS
CATSKILL NY
12414-1237
US

IV. Provider business mailing address

PO BOX 2000
HUDSON NY
12534-2000
US

V. Phone/Fax

Practice location:
  • Phone: 518-943-1048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRYAN T MAHONEY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 518-828-8090