Organization
MEADVILLE MEDICAL CENTER
Active
Other names
MEADVILLE UROLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
CORY FRANK JACKSON (CONTROLLER)
(814) 333-5766
Entity
Organization
Contact information
Practice address
765 LIBERTY ST STE 207A, MEADVILLE, PA 16335
(814) 373-2156
(814) 373-2159
Mailing address
1034 GROVE ST, MEADVILLE, PA 16335-2945
(814) 373-3434
(814) 373-2159
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Enumeration date
06/05/2018
Last updated
08/08/2018
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