Provider Demographics
NPI:1902800352
Name:UNITED MEMORIAL MEDICAL CENTER
Entity Type:Organization
Organization Name:UNITED MEMORIAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:DAMIAN
Authorized Official - Last Name:GLASTONBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-1595
Mailing Address - Street 1:127 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1631
Mailing Address - Country:US
Mailing Address - Phone:585-344-5428
Mailing Address - Fax:585-344-7470
Practice Address - Street 1:127 NORTH ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1631
Practice Address - Country:US
Practice Address - Phone:585-344-5428
Practice Address - Fax:585-344-7470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QU0200X
NY282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354283Medicaid
NY016OtherCOMMUNITY BLUE
NY4VOtherINDEPENDE HEALTH
NYP014001947OtherPREMIER HEALTH
NY016OtherBLUE CROSS WNY
NY=========OtherPROVIDER NUMBER