Provider Demographics
NPI:1255349981
Name:TITUSVILLE AREA HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:TITUSVILLE AREA HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:814-827-1852
Mailing Address - Street 1:335 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1416
Mailing Address - Country:US
Mailing Address - Phone:814-827-1852
Mailing Address - Fax:814-827-8419
Practice Address - Street 1:406 W OAK ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1404
Practice Address - Country:US
Practice Address - Phone:814-827-9770
Practice Address - Fax:814-827-3556
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TITUSVILLE AREA HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-05
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD440393207X00000X
208800000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007717100023Medicaid
PA1007717100006Medicaid
PA1007717100020Medicaid
PACG6962OtherRAILROAD MEDICARE
PACG6962OtherRAILROAD MEDICARE