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General NPI Number Information
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NPI Number | 1538244900
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Entity Type | Organization
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Legal Business Name | CORRY MEDICAL SERVICES, INC.
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 300 YORK ST
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City | CORRY
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State | PA
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Zip | 16407-1420
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Country | US
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Telephone | 814-665-8288
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Fax | 814-664-8618
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Provider Business Mailing Address
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Address Line | PO BOX 76642
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City | CLEVELAND
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State | OH
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Zip | 44101-6500
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Country | US
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Telephone | 330-759-9119
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Fax | 330-759-3330
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Authorized Official
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Title or Position | CFO
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Name | MR. MICHAEL HELLER
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Credential |
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Telephone | 814-664-4641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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