Provider Demographics
NPI:1992073571
Name:MERCY HOSPITAL OF BUFFALO
Entity type:Organization
Organization Name:MERCY HOSPITAL OF BUFFALO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:URLAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-828-2008
Mailing Address - Street 1:2875 UNION RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1465
Mailing Address - Country:US
Mailing Address - Phone:716-651-0911
Mailing Address - Fax:716-651-9855
Practice Address - Street 1:565 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-2039
Practice Address - Country:US
Practice Address - Phone:716-826-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HOSPITAL OF BUFFALO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-09
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03639407Medicaid
J100061692Medicare PIN