Healthcare Provider Details

I. General information

NPI: 1215044516
Provider Name (Legal Business Name): SOLDIERS & SAILORS MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 N MAIN ST
PENN YAN NY
14527-1085
US

IV. Provider business mailing address

418 N MAIN ST
PENN YAN NY
14527-1085
US

V. Phone/Fax

Practice location:
  • Phone: 315-787-4150
  • Fax: 315-787-4794
Mailing address:
  • Phone: 315-787-4150
  • Fax: 315-787-4794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberEIN
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. PAMELA E JOHNSON
Title or Position: TREASURER/CFO
Credential:
Phone: 315-787-4031