=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740837806
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED HEALTH SERVICES HOSPITALS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2019
-----------------------------------------------------
Last Update Date | 03/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 345 MAIN ST STE A
-----------------------------------------------------
City | JOHNSON CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13790-2050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-352-5948
-----------------------------------------------------
Fax | 607-352-5949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 345 MAIN ST STE A
-----------------------------------------------------
City | JOHNSON CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13790-2050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-352-5948
-----------------------------------------------------
Fax | 607-352-5949
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | WILLIAM G WALDRON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 607-763-1835
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------