Organization
BUCKTAIL MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY DAILEY JR. (ACCOUNTING / SPECIAL PROJECTS)
(570) 923-1000
Entity
Organization
Contact information
Practice address
1001 PINE ST, RENOVO, PA 17764-1618
(570) 923-1000
(570) 923-1812
Mailing address
1001 PINE ST, RENOVO, PA 17764-1618
(570) 923-1000
(570) 923-1812
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
549601
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007644390002
—
PA
05
—
1007644390003
—
PA
05
—
1007644390004
—
PA
05
—
1007644390007
—
PA
05
—
1007644390010
—
PA
Enumeration date
09/15/2005
Last updated
03/17/2023
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