MEDICARE: COLUMBIA MEMORIAL 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	261QM1300X	Multi-Specialty Clinic/Center	1001000H	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W79533	OTHER	NY	MEDICARE GROUP

General Provider Information

NPI Number	:	1730435694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBIA MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 2000
Second Line	:
City	:	HUDSON
State	:	NY
Zip	:	12534-2000
Country	:	US
Telephone Number	:	518-828-8066
Fax Number	:	518-828-8183

Provider Business Practice Location Address
First Line	:	71 PROSPECT AVENUE
Second Line	:	SUITE 110
City	:	HUDSON
State	:	NY
Zip	:	12534
Country	:	US
Telephone Number	:	518-697-8191
Fax Number	:	518-697-5353

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DOROTHY URSCHEL
Credential	:
Telephone Number	:	518-828-8374

Provider Enumeration Date	:	07/30/2012
Last Update Date	:	06/03/2026

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Directions to “COLUMBIA MEMORIAL HOSPITAL ” Practice Location

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