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General NPI Number Information
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NPI Number | 1316940745
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Entity Type | Organization
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Legal Business Name | EDWARD JOHN NOBLE HOSPITAL OF GOUVERNEUR NY
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 77 W BARNEY ST
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City | GOUVERNEUR
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State | NY
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Zip | 13642-1040
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Country | US
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Telephone | 315-535-9244
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Fax | 315-535-9305
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Provider Business Mailing Address
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Address Line | 77 W BARNEY ST
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City | GOUVERNEUR
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State | NY
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Zip | 13642-1040
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Country | US
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Telephone | 315-287-1000
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Fax | 315-535-9207
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Authorized Official
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Title or Position | PATIENT ACCOUNTING SUPERVISOR
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Name | PATRICIA ROGERS
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Credential |
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Telephone | 315-287-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 013468
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 4423000C
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | 4423000H
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License Number State | NY
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