Provider Demographics
NPI:1679733950
Name:TYRONE MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:TYRONE MEDICAL ASSOCIATES
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 1:3 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:
Practice Address - Street 1:3 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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TYRONE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-11
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053392363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty