Provider Demographics
NPI: | 1558545376 |
---|---|
Name: | TYRONE HOSPITAL |
Entity Type: | Organization |
Organization Name: | TYRONE HOSPITAL |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANNA |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | ANNA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 814-684-1255 |
Mailing Address - Street 1: | 225 HOSPITAL DR |
Mailing Address - Street 2: | |
Mailing Address - City: | TYRONE |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 16686-1802 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 814-684-3101 |
Mailing Address - Fax: | 814-684-5539 |
Practice Address - Street 1: | 225 HOSPITAL DR |
Practice Address - Street 2: | |
Practice Address - City: | TYRONE |
Practice Address - State: | PA |
Practice Address - Zip Code: | 16686-1802 |
Practice Address - Country: | US |
Practice Address - Phone: | 814-684-3101 |
Practice Address - Fax: | 814-684-5539 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | TYRONE HOSPITAL |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2007-12-28 |
Last Update Date: | 2019-05-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QC0050X | Ambulatory Health Care Facilities | Clinic/Center | Critical Access Hospital |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 1007734000023 | Medicaid |