Healthcare Provider Details

I. General information

NPI: 1912950643
Provider Name (Legal Business Name): MARGARETVILLE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42084 STATE HIGHWAY 28
MARGARETVILLE NY
12455
US

IV. Provider business mailing address

42084 STATE HIGHWAY 28
MARGARETVILLE NY
12455-2820
US

V. Phone/Fax

Practice location:
  • Phone: 845-586-2631
  • Fax: 845-943-6077
Mailing address:
  • Phone: 845-586-2631
  • Fax: 845-586-2976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1203
License Number StateNY

VIII. Authorized Official

Name: MR. MARK POHAR
Title or Position: CEO
Credential: CEO
Phone: 845-586-2631