Healthcare Provider Details

I. General information

NPI: 1033283437
Provider Name (Legal Business Name): CHARLES COLE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 ELK ST
COUDERSPORT PA
16915-9601
US

IV. Provider business mailing address

71 ELK ST
COUDERSPORT PA
16915-9601
US

V. Phone/Fax

Practice location:
  • Phone: 814-274-5577
  • Fax: 814-274-8709
Mailing address:
  • Phone: 814-274-5577
  • Fax: 814-274-8709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL JAMES GLUNK
Title or Position: INTERIM PRESIDENT
Credential:
Phone: 570-321-2284