Provider Demographics
NPI:1881926533
Name:CARTHAGE AREA HOSPITAL, INC.
Entity type:Organization
Organization Name:CARTHAGE AREA HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-519-5201
Mailing Address - Street 1:20414 SUNSET AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAFARGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13656-2222
Mailing Address - Country:US
Mailing Address - Phone:315-493-1000
Mailing Address - Fax:315-493-0105
Practice Address - Street 1:20414 SUNSET AVENUE
Practice Address - Street 2:
Practice Address - City:LAFARGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13656-2222
Practice Address - Country:US
Practice Address - Phone:315-493-1000
Practice Address - Fax:315-493-0105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARTHAGE AREA HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2238001H261QS1000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05797833Medicaid
333987OtherMEDICARE PTAN
NY330263Medicare Oscar/Certification