Provider Demographics
NPI:1962618405
Name:ERIE COUNTY MEDICAL CENTER CORPORATION
Entity type:Organization
Organization Name:ERIE COUNTY MEDICAL CENTER CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-898-5931
Mailing Address - Street 1:462 GRIDER ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-898-5931
Mailing Address - Fax:716-898-5178
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-5931
Practice Address - Fax:716-898-5178
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERIE COUNTY MEDICAL CENTER CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-14
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1401005N314000000X
NY1420300N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11412205OtherUNIVERA SKILLED NURSING
NY000000250000OtherBLUE CROSS ERIE CTY HOME
NY11439102OtherUNIVERA ERIE COUNTY HOME
NY312327Medicaid
NY000000319000OtherBLUE CROSS SKILLED NURSIN
NY708205Medicaid
NYI3OtherIHA SKILLED NURSING
NYJ7OtherIHA ERIE COUNTY HOME
NY000000319000OtherBLUE CROSS SKILLED NURSIN