Healthcare Provider Details

I. General information

NPI: 1114954682
Provider Name (Legal Business Name): ALICE HYDE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 PARK ST
MALONE NY
12953-1220
US

IV. Provider business mailing address

133 PARK ST
MALONE NY
12953-1220
US

V. Phone/Fax

Practice location:
  • Phone: 518-481-2210
  • Fax: 518-481-2662
Mailing address:
  • Phone: 518-481-2210
  • Fax: 518-481-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1624000H
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. MATEJ KOLLAR
Title or Position: CFO
Credential:
Phone: 518-481-8065