Organization
OLEAN GENERAL HOSPITAL
Active
Other names
Foothills Medical Group at BRMC RHC
Organization subpart
No
Provider details
NPI number
Authorized official
JILL M OWENS MD (CEO)
(716) 373-2600
Entity
Organization
Contact information
Practice address
116 INTERSTATE PKWY, SUITE 42, BRADFORD, PA 16701-1036
(814) 362-8390
(814) 362-8385
Mailing address
116 INTERSTATE PKWY, BRADFORD, PA 16701-1036
(814) 368-4143
(814) 362-8385
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5141201
PA
208000000X
Pediatrics Physician
Primary
5141201
PA
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007755030043
—
PA
01
—
393420
CMS CERTIFICATION
PA
Enumeration date
04/11/2013
Last updated
10/10/2023
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