Provider Demographics
NPI:1851369938
Name:CORRY MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:CORRY MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:SWING BED UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:PATIENT ACCOUNTING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRISH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HURD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-664-4641
Mailing Address - Street 1:965 SHAMROCK LANE
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407
Mailing Address - Country:US
Mailing Address - Phone:814-664-4641
Mailing Address - Fax:814-664-8799
Practice Address - Street 1:965 SHAMROCK LANE
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407
Practice Address - Country:US
Practice Address - Phone:814-664-4641
Practice Address - Fax:814-664-8799
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORRY MEMORIAL HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-14
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA39Z308Medicare ID - Type UnspecifiedTCP UNIT