Healthcare Provider Details

I. General information

NPI: 1154217776
Provider Name (Legal Business Name): COLUMBIA MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 MOUNTAIN VIEW RD
COPAKE NY
12516-1201
US

IV. Provider business mailing address

71 PROSPECT AVE
HUDSON NY
12534-2927
US

V. Phone/Fax

Practice location:
  • Phone: 518-329-3902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRYAN T MAHONEY
Title or Position: CFO
Credential:
Phone: 518-828-8090