Healthcare Provider Details

I. General information

NPI: 1760800635
Provider Name (Legal Business Name): GLENS FALLS HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARK ST EMERGENCY CARE CENTER
GLENS FALLS NY
12801-4413
US

IV. Provider business mailing address

100 PARK ST EMERGENCY CARE CENTER
GLENS FALLS NY
12801-4413
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-6992
  • Fax: 518-926-6983
Mailing address:
  • Phone: 518-926-6992
  • Fax: 518-926-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MITCHELL AMADO
Title or Position: SVP FINANCE AND CFO
Credential:
Phone: 518-926-5113