Provider Demographics
NPI:1518411677
Name:CORRY MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:CORRY MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:MULTI SPECIALTY GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
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 1:965 SHAMROCK LN
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-9121
Mailing Address - Country:US
Mailing Address - Phone:814-664-4641
Mailing Address - Fax:
Practice Address - Street 1:965 SHAMROCK LN
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-9121
Practice Address - Country:US
Practice Address - Phone:814-664-4641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORRY MEMORIAL HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-06
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03400101282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA391308Medicare Oscar/Certification