Healthcare Provider Details

I. General information

NPI: 1568548782
Provider Name (Legal Business Name): CANTON-POTSDAM HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LEROY STREET
POTSDAM NY
13676
US

IV. Provider business mailing address

50 LEROY ST
POTSDAM NY
13676-1786
US

V. Phone/Fax

Practice location:
  • Phone: 315-265-3300
  • Fax: 315-261-6412
Mailing address:
  • Phone: 315-265-3300
  • Fax: 315-261-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberOP CERT 4429000H
License Number StateNY

VIII. Authorized Official

Name: DONNA MCGREGOR
Title or Position: CFO
Credential:
Phone: 315-265-6059