MEDICARE: MARY IMOGENE BASSETT HOSPITAL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1639726565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY IMOGENE BASSETT HOSPITAL

Provider Business Mailing Address
First Line	:	1 ATWELL RD
Second Line	:
City	:	COOPERSTOWN
State	:	NY
Zip	:	13326-1301
Country	:	US
Telephone Number	:	607-547-3456
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 MONTGOMERY ST
Second Line	:
City	:	CANAJOHARIE
State	:	NY
Zip	:	13317-1212
Country	:	US
Telephone Number	:	518-673-5555
Fax Number	:	518-673-5761

Authorized Official
Title or Position	:	NETWORK CFO AND BMC VP
Name	:	PAUL SWINKO
Credential	:
Telephone Number	:	607-547-3096

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	08/26/2019

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