Basic Information
| Provider Information | |||||||||
| NPI: | 1083655492 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KENMORE MERCY HOSPITAL | ||||||||
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| OtherOrganizationName: | KENMORE SPECIALTY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 908 NIAGARA FALLS BLVD | ||||||||
| Address2: | STE. 208 | ||||||||
| City: | N TONAWANDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141202019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166922160 | ||||||||
| FaxNumber: | 7166924342 | ||||||||
| Practice Location | |||||||||
| Address1: | 2950 ELMWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | KENMORE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142171304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164476100 | ||||||||
| FaxNumber: | 7166924342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 10/15/2007 | ||||||||
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| AuthorizedOfficialLastName: | KOHLMEIER | ||||||||
| AuthorizedOfficialFirstName: | CECELIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR, PRIMARY CARE CENTERS | ||||||||
| AuthorizedOfficialTelephone: | 7164476454 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.