Healthcare Provider Details

I. General information

NPI: 1306494844
Provider Name (Legal Business Name): MARY IMOGENE BASSETT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28650 ROUTE 23
STAMFORD NY
12167-1718
US

IV. Provider business mailing address

1 ATWELL RD
COOPERSTOWN NY
13326-1301
US

V. Phone/Fax

Practice location:
  • Phone: 607-652-2537
  • Fax: 607-652-2719
Mailing address:
  • Phone: 607-652-2537
  • Fax: 607-652-2719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL SWINKO
Title or Position: NETWORK CFO AND BMC VP
Credential:
Phone: 607-547-3096