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General NPI Number Information
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NPI Number | 1184958761
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Entity Type | Organization
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Legal Business Name | SUPPLEMENTAL HEALTHCARE
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 2005 SHERIDAN DR
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City | BUFFALO
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State | NY
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Zip | 14223-1222
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Country | US
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Telephone | 716-541-9101
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 SHERIDAN DR
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City | BUFFALO
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State | NY
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Zip | 14223-1222
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Country | US
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Telephone | 716-541-9101
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Fax |
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Authorized Official
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Title or Position | MARKET MANAGER
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Name | RICK MAJORS
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Credential |
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Telephone | 716-541-9101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 2003101977
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License Number State | DE
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