Provider Demographics
NPI:1184958761
Name:SUPPLEMENTAL HEALTHCARE
Entity type:Organization
Organization Name:SUPPLEMENTAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKET MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-541-9101
Mailing Address - Street 1:2005 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1222
Mailing Address - Country:US
Mailing Address - Phone:716-541-9101
Mailing Address - Fax:
Practice Address - Street 1:2005 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-1222
Practice Address - Country:US
Practice Address - Phone:716-541-9101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUPPLEMENTAL HEALTHCARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2003101977282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital