Healthcare Provider Details

I. General information

NPI: 1750798641
Provider Name (Legal Business Name): TYRONE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2014
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 CRICKLEWOOD DR
STATE COLLEGE PA
16803-1899
US

IV. Provider business mailing address

187 HOSPITAL DR
TYRONE PA
16686-1808
US

V. Phone/Fax

Practice location:
  • Phone: 814-234-2226
  • Fax: 814-234-2258
Mailing address:
  • Phone: 814-684-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA056979
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANNA M ANNA
Title or Position: CEO
Credential:
Phone: 814-684-1255