Healthcare Provider Details

I. General information

NPI: 1922354778
Provider Name (Legal Business Name): COLUMBIA MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 RIVER ST SUITE 108
VALATIE NY
12184-9694
US

IV. Provider business mailing address

PO BOX 2000
HUDSON NY
12534-2000
US

V. Phone/Fax

Practice location:
  • Phone: 518-758-8300
  • Fax: 518-758-9679
Mailing address:
  • Phone: 518-828-8363
  • Fax: 518-697-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number1001000H
License Number StateNY

VIII. Authorized Official

Name: MR. VINCENT J DINGMAN III
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 518-828-8249