Healthcare Provider Details

I. General information

NPI: 1992707608
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BROAD ST
HAMILTON NY
13346-9575
US

IV. Provider business mailing address

150 BROAD ST
HAMILTON NY
13346-9575
US

V. Phone/Fax

Practice location:
  • Phone: 315-824-6082
  • Fax: 315-824-3182
Mailing address:
  • Phone: 315-824-6082
  • Fax: 315-824-3182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2625000H
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number2625700C
License Number StateNY

VIII. Authorized Official

Name: JEFFERY COAKLEY
Title or Position: CEO AND PRESIDENT
Credential:
Phone: 315-806-0909