# MEADVILLE MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Meadville Endocrinology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790477586
- **Authorized official:** CORY FRANK JACKSON (CONTROLLER)
- **Authorized official phone:** (814) 333-5766

## Contact information

- **Practice address:** 765 LIBERTY ST STE 307A, MEADVILLE, PA 16335-2566
- **Practice address phone:** (814) 373-4270
- **Practice address fax:** (814) 373-4273
- **Mailing address:** 1034 GROVE ST, MEADVILLE, PA 16335-2945
- **Mailing address phone:** (814) 373-4270
- **Mailing address fax:** (814) 373-4273

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/22/2023
- **Last updated:** 05/22/2023