Healthcare Provider Details

I. General information

NPI: 1215194501
Provider Name (Legal Business Name): GENEVA GENERAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 NORTH ST
GENEVA NY
14456-1651
US

IV. Provider business mailing address

196 NORTH ST
GENEVA NY
14456-1651
US

V. Phone/Fax

Practice location:
  • Phone: 315-787-4150
  • Fax: 315-787-4794
Mailing address:
  • Phone: 315-787-4150
  • Fax: 315-787-4794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. PAMELA E JOHNSON
Title or Position: TREASURER CFO
Credential:
Phone: 315-787-4030