Healthcare Provider Details

I. General information

NPI: 1164436283
Provider Name (Legal Business Name): KENMORE MERCY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 ELMWOOD AVE
KENMORE NY
14217-1304
US

IV. Provider business mailing address

2950 ELMWOOD AVE
KENMORE NY
14217-1304
US

V. Phone/Fax

Practice location:
  • Phone: 716-447-6100
  • Fax:
Mailing address:
  • Phone: 716-447-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number1404030H
License Number StateNY

VIII. Authorized Official

Name: DAVID P MACHOLZ
Title or Position: CFO
Credential:
Phone: 716-601-3690