=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073883948
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWN OF MASSENA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2012
-----------------------------------------------------
Last Update Date | 01/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HOSPITAL DR
-----------------------------------------------------
City | MASSENA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13662-1056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-769-4347
-----------------------------------------------------
Fax | 315-769-4780
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 HOSPITAL DR
-----------------------------------------------------
City | MASSENA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13662-1056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-769-4347
-----------------------------------------------------
Fax | 315-769-4780
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | CHARLES F FAHD II
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-769-4233
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 4402000H
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------