Provider Demographics
NPI:1699742270
Name:ST JAMES MERCY HEALTH
Entity type:Organization
Organization Name:ST JAMES MERCY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAPONE
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 1:411 CANISTEO ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-2104
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:2006-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X, 261QM0855X
NY5002001H273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Not Answered273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00363162Medicaid
NY33S151Medicare ID - Type Unspecified