Organization
COLE CARE
Active
Other names
CCMH CRNA
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER C. YOST (CFO)
(570) 321-3175
Entity
Organization
Contact information
Practice address
1001 E 2ND ST, COUDERSPORT, PA 16915-8161
(814) 274-9300
Mailing address
1001 E 2ND ST, COUDERSPORT, PA 16915-8161
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001917723
BLUE SHIELD
PA
Enumeration date
06/05/2007
Last updated
04/04/2024
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