Healthcare Provider Details

I. General information

NPI: 1184252751
Provider Name (Legal Business Name): MOUNT ST. MARY'S HOSPITAL OF NIAGARA FALLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 MILITARY RD
LEWISTON NY
14092-1903
US

IV. Provider business mailing address

144 GENESEE ST FL 3
BUFFALO NY
14203-1560
US

V. Phone/Fax

Practice location:
  • Phone: 716-297-4800
  • Fax:
Mailing address:
  • Phone: 716-601-3600
  • Fax: 716-601-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0404X
TaxonomyCardiac Rehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

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