Provider Demographics
NPI:1326139775
Name:MEADVILLE MEDICAL CENTER
Entity Type:Organization
Organization Name:MEADVILLE MEDICAL CENTER
Other - Org Name:YOLANDA G. BARCO ONCOLOGY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUNTAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-333-5031
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:CBO
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-373-2923
Mailing Address - Fax:814-333-5640
Practice Address - Street 1:16792 CONNEAUT LAKE RD
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3748
Practice Address - Country:US
Practice Address - Phone:814-373-2335
Practice Address - Fax:814-373-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA097225Medicare ID - Type Unspecified