# COLUMBIA MEMORIAL REGIONAL MEDICAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CMH-Lafayette Family Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417540824
- **Authorized official:** BRYAN T. MAHONEY (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (518) 828-8090

## Contact information

- **Practice address:** 24 LAFAYETTE AVE, COXSACKIE, NY 12051-1305
- **Practice address phone:** (518) 731-7770
- **Mailing address:** PO BOX 2000, HUDSON, NY 12534-2000
- **Mailing address phone:** (518) 828-8051

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/17/2021
- **Last updated:** 07/21/2021