MEDICARE: ST. CLARES HOSPITAL

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	4601002H	NY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000926	OTHER	NY	BLUE CROSS
2	040401000452	OTHER	NY	FIDELIS
3	10005832	OTHER	NY	CDPHP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000400036000	OTHER	NY	BLUE SHIELD
6	04606	OTHER	NY	GHI
7	025	OTHER	NY	MOHAWK VALLEY PHYSICIANS

NPI Number	:	1801886072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. CLARES HOSPITAL

Provider Business Mailing Address
First Line	:	600 MCCLELLAN ST
Second Line	:
City	:	SCHENECTADY
State	:	NY
Zip	:	12304-1009
Country	:	US
Telephone Number	:	518-347-5660
Fax Number	:	518-347-5409

Provider Business Practice Location Address
First Line	:	600 MCCLELLAN ST
Second Line	:
City	:	SCHENECTADY
State	:	NY
Zip	:	12304-1009
Country	:	US
Telephone Number	:	518-347-5666
Fax Number	:	518-347-5409

Authorized Official
Title or Position	:	VICE PRESIDENT OF FINANCE, CFO
Name	:	MR. EDWARD GASPAROVIC
Credential	:
Telephone Number	:	518-347-5666

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	09/04/2007

600 MCCLELLAN ST , ST CLAIRES HOSPITAL WOUND CARE CENTER
SCHENECTADY, NY
12304-1009

Practice Phone: 518-347-5442
Practice Fax: 518-347-5330