Provider Demographics
NPI:1689673022
Name:BRADFORD REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:BRADFORD REGIONAL MEDICAL CENTER
Other - Org Name:MCKEAN COUNTY VISTING NURSE ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FINAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-362-8216
Mailing Address - Street 1:1223 E MAIN ST
Mailing Address - Street 2:PO BOX 465
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-3223
Mailing Address - Country:US
Mailing Address - Phone:814-362-7466
Mailing Address - Fax:814-362-4306
Practice Address - Street 1:1223 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3223
Practice Address - Country:US
Practice Address - Phone:814-362-7466
Practice Address - Fax:814-362-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA713005251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007507650048Medicaid
PA397130BMedicare ID - Type UnspecifiedHOME HEALTH AGENCY