Healthcare Provider Details

I. General information

NPI: 1093864183
Provider Name (Legal Business Name): TITUSVILLE AREA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W OAK ST
TITUSVILLE PA
16354-1404
US

IV. Provider business mailing address

406 W OAK ST
TITUSVILLE PA
16354-1404
US

V. Phone/Fax

Practice location:
  • Phone: 814-827-1851
  • Fax: 814-827-3099
Mailing address:
  • Phone: 814-827-1851
  • Fax: 814-827-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number200901
License Number StatePA

VIII. Authorized Official

Name: PAUL A MATTIS
Title or Position: VP FINANCE CFO
Credential:
Phone: 814-827-1852