St Joseph'S Hospital Health Center

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

ST JOSEPH'S HOSPITAL HEALTH CENTER

Practice address

4105 Medical Center Dr
Fayetteville, NY 13066-6636

Phone

(315) 329-7200

Fax

(315) 329-7203

NPI assigned

Jul 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael Shaffer

Title

VP of Fiscal Affairs, Cfo

Phone

(315) 448-5880

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225756800000",
    "number": "1184654212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 PROSPECT AVE",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132031807",
            "telephone_number": "315-448-5880",
            "fax_number": "315-448-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4105 MEDICAL CENTER DR",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666636",
            "telephone_number": "315-329-7200",
            "fax_number": "315-329-7203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH'S HOSPITAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2008-11-04",
        "status": "A",
        "authorized_official_last_name": "SHAFFER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "VP OF FISCAL AFFAIRS, CFO",
        "authorized_official_telephone_number": "315-448-5880",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00315013",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02995893",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carly Antoinette Spetrino, LMT
• Jacob S Spillane
• Caitlin Spinelli
• Kerry Elizabeth Spitze, MS, NCC, LMHC
• Lisa Sprague, LPN
• St. Joseph'S Imaging
• Jud Staller, M.D.
• Kimberly J Staniec-Pinkerton, SLP
• Jennifer Starowicz
• Vicki Lynn Stenuf, RPH

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fayetteville, NY
• Providers in Fayetteville, NY by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.