Provider Demographics
NPI:1780857011
Name:CORRY MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:CORRY MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:VAUGH BUILDING RURAL HEALTH CLINIC
Other - Org Type:Other Name
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 1:300 YORK ST
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-1420
Mailing Address - Country:US
Mailing Address - Phone:814-665-8288
Mailing Address - Fax:814-664-8618
Practice Address - Street 1:300 YORK ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1420
Practice Address - Country:US
Practice Address - Phone:814-665-8288
Practice Address - Fax:814-664-8618
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORRY MEMORIAL HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-08
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty