Healthcare Provider Details

I. General information

NPI: 1629153093
Provider Name (Legal Business Name): CORRY MEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 W SMITH ST
CORRY PA
16407-1152
US

IV. Provider business mailing address

612 W SMITH ST
CORRY PA
16407-1152
US

V. Phone/Fax

Practice location:
  • Phone: 814-664-4641
  • Fax: 814-663-9900
Mailing address:
  • Phone: 814-664-4641
  • Fax: 814-663-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL HELLER
Title or Position: CFO
Credential:
Phone: 814-664-4641