Provider Demographics
NPI:1104893320
Name:ST JAMES MERCY HOSPITAL
Entity type:Organization
Organization Name:ST JAMES MERCY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-324-8113
Mailing Address - Street 1:411 CANISTEO ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-2104
Mailing Address - Country:US
Mailing Address - Phone:607-324-8000
Mailing Address - Fax:607-324-8198
Practice Address - Street 1:1 BETHESDA DR
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1048
Practice Address - Country:US
Practice Address - Phone:607-324-8000
Practice Address - Fax:607-324-8198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5002001H281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00363162Medicaid
NY00363162Medicaid