Provider Demographics
NPI:1639189889
Name:TITUSVILLE AREA HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:TITUSVILLE AREA HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:814-827-1852
Mailing Address - Street 1:335 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1416
Mailing Address - Country:US
Mailing Address - Phone:814-827-1852
Mailing Address - Fax:814-827-8419
Practice Address - Street 1:335 W OAK ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1416
Practice Address - Country:US
Practice Address - Phone:814-827-1852
Practice Address - Fax:814-827-8419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007717100022Medicaid
PA1007717100006Medicaid
PA1007717100008Medicaid
PA1007717100009Medicaid
PA1007717100010Medicaid
PA1007717100021Medicaid
PACH2780OtherRAILROAD MEDICARE
PACH2780OtherRAILROAD MEDICARE