=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003923434
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST. LUKE'S CORNWALL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2006
-----------------------------------------------------
Last Update Date | 02/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 DUBOIS ST
-----------------------------------------------------
City | NEWBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12550-4851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-561-4400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 DUBOIS ST
-----------------------------------------------------
City | NEWBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12550-4851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-561-4400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT OF REVENUE CYCLE
-----------------------------------------------------
Name | MRS. JILL BARTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-568-2770
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 3522000H
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------