Provider Demographics
NPI:1043331937
Name:CROUSE HOSPITAL
Entity type:Organization
Organization Name:CROUSE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:315-464-4036
Mailing Address - Street 1:7804 RAVENSWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-2414
Mailing Address - Country:US
Mailing Address - Phone:315-464-4036
Mailing Address - Fax:
Practice Address - Street 1:CROUSE HOSPITAL
Practice Address - Street 2:736 IRVING AVE.
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-4036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300481-1282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital