Provider Demographics
NPI:1740205426
Name:GUTHRIE TOWANDA MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:GUTHRIE TOWANDA MEMORIAL HOSPITAL
Other - Org Name:GUTHRIE TOWANDA MEMORIAL HOSPITAL EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:J
Authorized Official - Last Name:COVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-268-2406
Mailing Address - Street 1:91 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-9702
Mailing Address - Country:US
Mailing Address - Phone:570-268-2406
Mailing Address - Fax:570-265-4797
Practice Address - Street 1:91 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848
Practice Address - Country:US
Practice Address - Phone:570-268-2406
Practice Address - Fax:570-265-4797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007713260013Medicaid
PA209739Medicare PIN
P01081525Medicare PIN