MEDICARE: ST. PETER'S HOSPITAL OF THE CITY OF ALBANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	282N00000X	General Acute Care Hospital
2	363A00000X	Physician Assistant
3	363L00000X	Nurse Practitioner
4	261QM1300X	Multi-Specialty Clinic/Center
5	363LA2100X	Acute Care Nurse Practitioner
6	207RH0003X	Hematology & Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144407024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. PETER'S HOSPITAL OF THE CITY OF ALBANY

Provider Business Mailing Address
First Line	:	PO BOX 14890
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12212-4890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 SOUTH MANNING BLVD SUITE 220
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208-1738
Country	:	US
Telephone Number	:	518-525-6418
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	COURTNEY KNOWLES
Credential	:
Telephone Number	:	518-525-5634

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	04/30/2024

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Directions to “ST. PETER'S HOSPITAL OF THE CITY OF ALBANY ” Practice Location

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