Healthcare Provider Details

I. General information

NPI: 1316940745
Provider Name (Legal Business Name): EDWARD JOHN NOBLE HOSPITAL OF GOUVERNEUR NY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W BARNEY ST
GOUVERNEUR NY
13642-1040
US

IV. Provider business mailing address

77 W BARNEY ST
GOUVERNEUR NY
13642-1040
US

V. Phone/Fax

Practice location:
  • Phone: 315-535-9244
  • Fax: 315-535-9305
Mailing address:
  • Phone: 315-287-1000
  • Fax: 315-535-9207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number013468
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number4423000C
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number4423000H
License Number StateNY

VIII. Authorized Official

Name: PATRICIA ROGERS
Title or Position: PATIENT ACCOUNTING SUPERVISOR
Credential:
Phone: 315-287-1000