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Organization

CCMH SURGICAL SPECIALISTS

Active
Parent organization
CHARLES COLE MEMORIAL HOSPITAL
Organization subpart
Yes

Provider details

NPI number
Legal business name
CHARLES COLE MEMORIAL HOSPITAL
Authorized official
ED PITCHFORD (CEO)
(814) 274-5216
Entity
Organization

Contact information

Practice address
1001 EAST SECOND STREET, COUDERSPORT, PA 16915
(814) 274-9300
Mailing address
1001 EAST SECOND STREET, COUDERSPORT, PA 16915
(814) 274-9300

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1867505
BLUE SHIELD PROVIDER #
PA
Enumeration date
12/26/2007
Last updated
12/26/2007
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