Provider Demographics
NPI:1033283437
Name:CHARLES COLE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CHARLES COLE MEMORIAL HOSPITAL
Other - Org Name:CENTRAL POTTER HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILFIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-723-0100
Mailing Address - Street 1:71 ELK ST
Mailing Address - Street 2:
Mailing Address - City:COUDERSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16915-9601
Mailing Address - Country:US
Mailing Address - Phone:814-274-5577
Mailing Address - Fax:814-274-8709
Practice Address - Street 1:71 ELK ST
Practice Address - Street 2:
Practice Address - City:COUDERSPORT
Practice Address - State:PA
Practice Address - Zip Code:16915-9601
Practice Address - Country:US
Practice Address - Phone:814-274-5577
Practice Address - Fax:814-274-8709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000011270126Medicaid
393418Medicare PIN