Organization
CHARLES COLE MEMORIAL HOSPITAL
Active
Other names
CCMH PHYSICAL MEDICINE AND REHABILITATION
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD PITCHFORD (CEO)
(814) 274-9300
Entity
Organization
Contact information
Practice address
1001 E 2ND ST, COUDERSPORT, PA 16915-8161
(814) 274-5300
Mailing address
1001 E 2ND ST, COUDERSPORT, PA 16915-8161
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1904616
PA BLUE SHIELD
PA
Enumeration date
04/17/2007
Last updated
08/13/2010
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