Provider Demographics
NPI:1396084505
Name:HUTHER DOYLE MEMORIAL INSTITUTE
Entity type:Organization
Organization Name:HUTHER DOYLE MEMORIAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-325-5100
Mailing Address - Street 1:360 EAST AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-2638
Mailing Address - Country:US
Mailing Address - Phone:585-325-5100
Mailing Address - Fax:585-325-5154
Practice Address - Street 1:360 EAST AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-2638
Practice Address - Country:US
Practice Address - Phone:585-325-5100
Practice Address - Fax:585-325-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2922374Medicaid
NY3257283Medicaid