Healthcare Provider Details

I. General information

NPI: 1063572733
Provider Name (Legal Business Name): MARY IMOGENE BASSETT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ATWELL RD
COOPERSTOWN NY
13326-1301
US

IV. Provider business mailing address

1 ATWELL RD
COOPERSTOWN NY
13326-1301
US

V. Phone/Fax

Practice location:
  • Phone: 607-547-3931
  • Fax: 607-547-6325
Mailing address:
  • Phone: 607-547-3931
  • Fax: 607-547-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. NICHOLAS J NICOLETTA
Title or Position: CORPORATE VICE PRESIDENT & CFO
Credential:
Phone: 607-547-3635