=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881926533
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARTHAGE AREA HOSPITAL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2010
-----------------------------------------------------
Last Update Date | 05/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20414 SUNSET AVENUE
-----------------------------------------------------
City | LAFARGEVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13656-2222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-493-1000
-----------------------------------------------------
Fax | 315-493-0105
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20414 SUNSET AVENUE
-----------------------------------------------------
City | LAFARGEVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13656-2222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-493-1000
-----------------------------------------------------
Fax | 315-493-0105
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. RICHARD DUVALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-519-5201
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1000X
-----------------------------------------------------
Taxonomy Name | Student Health Clinic/Center
-----------------------------------------------------
License Number | 2238001H
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------