Provider Demographics
NPI:1144262908
Name:MERCY HOSPITAL OF BUFFALO
Entity type:Organization
Organization Name:MERCY HOSPITAL OF BUFFALO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:URLAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-828-2008
Mailing Address - Street 1:55 MELROY AVE
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-1658
Mailing Address - Country:US
Mailing Address - Phone:716-819-5300
Mailing Address - Fax:716-819-5299
Practice Address - Street 1:565 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-2039
Practice Address - Country:US
Practice Address - Phone:716-826-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1401008N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00475301Medicaid
NY0011412901OtherUNIVERA HEALTHCARE
NY93OtherINDEPENDENT HEALTH
NY107OtherHEALTHNOW
NY40401000064OtherFIDELIS
NY93OtherINDEPENDENT HEALTH
NY40401000064OtherFIDELIS