Healthcare Provider Details

I. General information

NPI: 1417664152
Provider Name (Legal Business Name): TYRONE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 HOSPITAL DR
TYRONE PA
16686-1808
US

IV. Provider business mailing address

187 HOSPITAL DR
TYRONE PA
16686-1808
US

V. Phone/Fax

Practice location:
  • Phone: 814-384-6333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246QH0000X
TaxonomyHematology Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: JOURDAN STRISHOCK
Title or Position: ENROLLMENT SUPERVISOR
Credential:
Phone: 814-375-6160