Healthcare Provider Details

I. General information

NPI: 1962463851
Provider Name (Legal Business Name): UNITED HEALTH SERVICES HOSPITALS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33-57 HARRISON ST.
JOHNSON CITY NY
13790
US

IV. Provider business mailing address

PO BOX 412685
BOSTON MA
02241-2685
US

V. Phone/Fax

Practice location:
  • Phone: 607-762-3027
  • Fax:
Mailing address:
  • Phone: 607-770-0025
  • Fax: 607-729-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: KATHLEEN KEARNEY O'BRIEN
Title or Position: DIRECTOR OF THIRD PARTY REIMBURSEME
Credential:
Phone: 607-762-3078