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General NPI Number Information
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NPI Number | 1629087580
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Entity Type | Organization
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Legal Business Name | OUR LADY OF LOURDES MEMORIAL HOSPITAL INC.
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 169 RIVERSIDE DR
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City | BINGHAMTON
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State | NY
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Zip | 13905-4246
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Country | US
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Telephone | 607-798-5111
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Fax | 607-798-6730
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Provider Business Mailing Address
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Address Line | 169 RIVERSIDE DR
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City | BINGHAMTON
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State | NY
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Zip | 13905-4246
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Country | US
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Telephone | 607-798-5111
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Fax | 607-798-6730
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Authorized Official
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Title or Position | AVP REVENUE SERVICES
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Name | LYNN SANNE
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Credential |
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Telephone | 607-584-5492
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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 | 0301001H
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License Number State | NY
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