Provider Demographics
NPI:1427119486
Name:CLAXTON-HEPBURN MEDICAL CENTER
Entity type:Organization
Organization Name:CLAXTON-HEPBURN MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-713-5354
Mailing Address - Street 1:214 KING ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-1142
Mailing Address - Country:US
Mailing Address - Phone:315-394-9718
Mailing Address - Fax:315-393-7250
Practice Address - Street 1:214 KING ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-1142
Practice Address - Country:US
Practice Address - Phone:315-393-8880
Practice Address - Fax:315-393-7250
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAXTON HEPBURN MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4401000H261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02966989Medicaid
NY00354072Medicaid
NY00354072Medicaid
NY70065AMedicare PIN
NYW53568Medicare UPIN