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General NPI Number Information
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NPI Number | 1518944735
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Entity Type | Organization
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Legal Business Name | BUCKTAIL MEDICAL CENTER
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 1001 PINE STREET
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City | RENOVO
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State | PA
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Zip | 17764-1618
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Country | US
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Telephone | 570-923-1000
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Fax | 570-923-1812
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Provider Business Mailing Address
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Address Line | 1001 PINE STREET
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City | RENOVO
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State | PA
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Zip | 17764-1618
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Country | US
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Telephone | 570-923-1000
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Fax | 570-923-1812
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Authorized Official
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Title or Position | ACCOUNTANT
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Name | GARY DAILEY
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Credential |
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Telephone | 570-923-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 05131
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 15023
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License Number State | PA
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