Healthcare Provider Details

I. General information

NPI: 1487616470
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: 11/01/2023
Certification Date: 11/01/2023
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: 814-274-9300
  • Fax:
Mailing address:
  • Phone: 814-274-9300
  • Fax: 814-274-7085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number031801
License Number StatePA

VIII. Authorized Official

Name: ROGER C. YOST
Title or Position: CFO
Credential:
Phone: 570-321-3175