Organization
WYOMING COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL A. CORCIMIGLIA (COO)
(585) 786-8940
Entity
Organization
Contact information
Practice address
400 N MAIN ST, WARSAW, NY 14569-1025
(585) 786-2233
(585) 786-1222
Mailing address
400 N MAIN ST, WARSAW, NY 14569-1025
(585) 786-2233
(585) 786-1222
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
—
—
282NR1301X
Rural Acute Care Hospital
Primary
6027000H
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000028000
BLUE CROSS WESTERN NY
NY
05
—
00310889
—
NY
01
—
30
EXCELLUS BLUE CROSS
NY
Enumeration date
12/27/2005
Last updated
04/15/2022
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