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Organization

OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC

Active
Other names
Hospice At Lourdes
Organization subpart
No

Provider details

NPI number
Authorized official
MR. BRIAN REGAN (SR VP & CFO)
(607) 798-5271
Entity
Organization

Contact information

Practice address
4102 OLD VESTAL RD, VESTAL, NY 13850-3531
(607) 798-5692
(607) 352-1738
Mailing address
4102 OLD VESTAL RD, VESTAL, NY 13850-3531
(607) 798-5692
(607) 352-1738

Taxonomy

Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
0301501F
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2105209
AETNA PROVIDER NUMBER
01
3300115
EMPIRE BC/BS PROVIDER NUM
NY
01
331505
BC/BS OF CENTRAL NY
NY
01
528113
MVP PROVIDER NUMBER
NY
05
955775
NY
Enumeration date
05/05/2006
Last updated
08/22/2007
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