Provider Demographics
NPI:1043091648
Name:ADIRONDACK MEDICAL CENTER
Entity type:Organization
Organization Name:ADIRONDACK MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADELE
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKREIGN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-897-4725
Mailing Address - Street 1:PO BOX 1380
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983
Mailing Address - Country:US
Mailing Address - Phone:518-897-4725
Mailing Address - Fax:518-897-2423
Practice Address - Street 1:203 OLD MILITARY RD
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-1738
Practice Address - Country:US
Practice Address - Phone:518-523-1327
Practice Address - Fax:518-523-9964
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADIRONDACK MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty