Provider Demographics
NPI:1629153093
Name:CORRY MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:CORRY MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
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 1:612 W SMITH ST
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-1152
Mailing Address - Country:US
Mailing Address - Phone:814-664-4641
Mailing Address - Fax:814-663-9900
Practice Address - Street 1:612 W SMITH ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1152
Practice Address - Country:US
Practice Address - Phone:814-664-4641
Practice Address - Fax:814-663-9900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORRY MEDICAL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-26
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADA8713OtherRAILROAD MEDICARE
PA1007733850011Medicaid
PA059706Medicare PIN