Provider Demographics
NPI:1215003199
Name:CORRY MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:CORRY MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-664-4641
Mailing Address - Street 1:PO BOX 76642
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-6500
Mailing Address - Country:US
Mailing Address - Phone:814-664-4641
Mailing Address - Fax:814-663-9900
Practice Address - Street 1:108 WEST SMITH STREET
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1152
Practice Address - Country:US
Practice Address - Phone:814-664-7037
Practice Address - Fax:814-664-7039
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORRY MEDICAL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-24
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACA9106OtherRAILROAD MEDICARE
PA1007733850026Medicaid
PACA9106OtherRAILROAD MEDICARE