Provider Demographics
NPI:1932354677
Name:MEMORIAL HOSPITAL INC OF TOWANDA PA
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL INC OF TOWANDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FISCAL AFFAIRS
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROHRBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-268-2207
Mailing Address - Street 1:ONE HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-9767
Mailing Address - Country:US
Mailing Address - Phone:570-268-2207
Mailing Address - Fax:570-265-4797
Practice Address - Street 1:ONE HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-9767
Practice Address - Country:US
Practice Address - Phone:570-268-2207
Practice Address - Fax:570-265-4797
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL INC OF TOWANDA PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA650201261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental