1922243393 NPI number — CHARLES COLE MEMORIAL HOSPITAL

Table of content: (NPI 1922243393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922243393 NPI number — CHARLES COLE MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES COLE MEMORIAL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922243393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 EAST SECOND STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COUDERSPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16915-8161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-274-9300
Provider Business Mailing Address Fax Number:
814-274-0807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
83 S MARVIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMETHPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16749-2031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-981-4887
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HILFIGER
Authorized Official First Name:
JANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-723-0100

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000011270125 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com