# CANTON-POTSDAM HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982813176
- **Authorized official:** JODIE L MATICE PTA (PHYSICAL THERAPIST ASSISTANT)
- **Authorized official phone:** (315) 261-5490

## Contact information

- **Practice address:** 80 E MAIN ST, CANTON, NY 13617-1450
- **Practice address phone:** (315) 261-5490
- **Practice address fax:** (315) 261-6490
- **Mailing address:** 281 LITTLE BOW RD, GOUVERNEUR, NY 13642-3154
- **Mailing address phone:** (315) 287-0982

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282NR1301X | Rural Acute Care Hospital | 004071-1 | NY | Yes |

## Other

- **Enumeration date:** 05/22/2007
- **Last updated:** 08/22/2020