Healthcare Provider Details

I. General information

NPI: 1780600577
Provider Name (Legal Business Name): MARY IMOGENE BASSETT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/13/2019
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: 607-547-3100
  • Fax: 607-547-3921
Mailing address:
  • Phone: 607-547-3100
  • Fax: 607-547-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number3824000H
License Number StateNY

VIII. Authorized Official

Name: PAUL G SWINKO JR.
Title or Position: BASSETT MEDICAL CENTER VP
Credential:
Phone: 607-547-3096