Provider Demographics
NPI:1619204641
Name:CHARLES COLE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CHARLES COLE MEMORIAL HOSPITAL
Other - Org Name:CENTRAL POTTER HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:PITCHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-274-9300
Mailing Address - Street 1:71 ELK ST
Mailing Address - Street 2:
Mailing Address - City:COUDERSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16915-9601
Mailing Address - Country:US
Mailing Address - Phone:814-274-7070
Mailing Address - Fax:
Practice Address - Street 1:71 ELK ST
Practice Address - Street 2:
Practice Address - City:COUDERSPORT
Practice Address - State:PA
Practice Address - Zip Code:16915-9601
Practice Address - Country:US
Practice Address - Phone:814-274-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care