Provider Demographics
NPI:1093864183
Name:TITUSVILLE AREA HOSPITAL
Entity Type:Organization
Organization Name:TITUSVILLE AREA HOSPITAL
Other - Org Name:SPU
Other - Org Type:Other Name
Authorized Official - Title/Position:VP FINANCE CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-827-1852
Mailing Address - Street 1:406 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1404
Mailing Address - Country:US
Mailing Address - Phone:814-827-1851
Mailing Address - Fax:814-827-3099
Practice Address - Street 1:406 W OAK ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1404
Practice Address - Country:US
Practice Address - Phone:814-827-1851
Practice Address - Fax:814-827-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA200901261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100746065-0019Medicaid