Healthcare Provider Details

I. General information

NPI: 1750528386
Provider Name (Legal Business Name): MARGARETVILLE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53545 STATE HWY 30
ROXBURY NY
12474
US

IV. Provider business mailing address

53545 STATE HWY 30
ROXBURY NY
12474
US

V. Phone/Fax

Practice location:
  • Phone: 601-326-4145
  • Fax: 607-326-7525
Mailing address:
  • Phone: 601-326-4145
  • Fax: 607-326-7525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1226701C
License Number StateNY

VIII. Authorized Official

Name: MR. EDMOND MORACHE
Title or Position: CEO
Credential:
Phone: 845-586-2631