Organization
BUCKTAIL MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY DAILEY (ACCOUNTANT)
(570) 923-1000
Entity
Organization
Contact information
Practice address
1001 PINE ST, RENOVO, PA 17764-1618
(570) 923-1019
(570) 923-1650
Mailing address
1001 PINE ST, RENOVO, PA 17764-1618
(570) 923-1019
(570) 923-1650
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
549601
PA
261QC0050X
Critical Access Hospital Clinic/Center
Primary
549601
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007644390003
—
PA
Enumeration date
07/20/2006
Last updated
03/17/2023
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