Provider Demographics
NPI:1245420066
Name:MERCY TYLER HOSPITAL
Entity Type:Organization
Organization Name:MERCY TYLER HOSPITAL
Other - Org Name:TYLER MEMORIAL HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FRANKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-348-7074
Mailing Address - Street 1:880 SR 6 W
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-6149
Mailing Address - Country:US
Mailing Address - Phone:570-836-2161
Mailing Address - Fax:570-836-1938
Practice Address - Street 1:880 SR 6 W
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-6149
Practice Address - Country:US
Practice Address - Phone:570-836-2161
Practice Address - Fax:570-836-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA460201261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007713080010Medicaid
PA390192Medicare PIN