Healthcare Provider Details

I. General information

NPI: 1275292633
Provider Name (Legal Business Name): CHENANGO MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 N BROAD ST
NORWICH NY
13815-1019
US

IV. Provider business mailing address

179 N BROAD ST
NORWICH NY
13815-1019
US

V. Phone/Fax

Practice location:
  • Phone: 607-337-4111
  • Fax: 607-337-4284
Mailing address:
  • Phone: 607-337-4111
  • Fax: 607-337-4284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DRAKE LAMEN
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 607-337-4113