=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114954682
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALICE HYDE MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2006
-----------------------------------------------------
Last Update Date | 07/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 133 PARK ST
-----------------------------------------------------
City | MALONE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12953-1220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-481-2210
-----------------------------------------------------
Fax | 518-481-2662
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 133 PARK ST
-----------------------------------------------------
City | MALONE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12953-1220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-481-2210
-----------------------------------------------------
Fax | 518-481-2818
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. MATEJ KOLLAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 518-481-8065
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 1624000H
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------