MEDICARE: LEWIS COUNTY GENERAL 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	207Q00000X	Family Medicine 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	:	1790857308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWIS COUNTY GENERAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 2337
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13220-2337
Country	:	US
Telephone Number	:	315-701-5610
Fax Number	:

Provider Business Practice Location Address
First Line	:	9559 MAIN STREET
Second Line	:
City	:	BEAVER FALLS
State	:	NY
Zip	:	13305
Country	:	US
Telephone Number	:	315-346-6824
Fax Number	:	315-346-6868

Authorized Official
Title or Position	:	COO
Name	:	MICHELE PRINCE
Credential	:
Telephone Number	:	315-376-5226

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	09/20/2019

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Directions to “LEWIS COUNTY GENERAL HOSPITAL ” Practice Location

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