Healthcare Provider Details

I. General information

NPI: 1497717474
Provider Name (Legal Business Name): CHARLES COLE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E 2ND ST
COUDERSPORT PA
16915
US

IV. Provider business mailing address

1001 E 2ND ST
COUDERSPORT PA
16915
US

V. Phone/Fax

Practice location:
  • Phone: 814-274-9301
  • Fax: 814-274-7085
Mailing address:
  • Phone: 814-274-9301
  • Fax: 814-274-7085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: ED PITCHFORD
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 814-274-9301