Healthcare Provider Details

I. General information

NPI: 1215003199
Provider Name (Legal Business Name): CORRY MEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WEST SMITH STREET
CORRY PA
16407-1152
US

IV. Provider business mailing address

PO BOX 76642
CLEVELAND OH
44101-6500
US

V. Phone/Fax

Practice location:
  • Phone: 814-664-7037
  • Fax: 814-664-7039
Mailing address:
  • Phone: 814-664-4641
  • Fax: 814-663-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

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