Provider Demographics
NPI:1124014691
Name:OLEAN GENERAL HOSPITAL
Entity Type:Organization
Organization Name:OLEAN GENERAL HOSPITAL
Other - Org Name:THE PAVILION AT BRMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-373-2600
Mailing Address - Street 1:200 PLEASANT STREET
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701
Mailing Address - Country:US
Mailing Address - Phone:814-362-8293
Mailing Address - Fax:814-363-5110
Practice Address - Street 1:200 PLEASANT STREET
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701
Practice Address - Country:US
Practice Address - Phone:814-362-8599
Practice Address - Fax:814-363-5110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLEAN GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-21
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA024702314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0517OtherHIGH MARK BLUE CROSS
PA1007507650046Medicaid
PA1007507650046Medicaid