BUCKTAIL MEDICAL CENTER (NPI# 1093701047) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093701047 |
| Entity Type | Organization |
| Organization Name | BUCKTAIL MEDICAL CENTER |
| Practice Address |
1001 Pine St Renovo PA 17764-1618 |
| Practice Telephone | 5709231000 |
| Practice Fax Number | 5709231812 |
| Mailing Telephone | 5709231000 |
| Mailing Fax Number | 5709231812 |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2016-03-03 |
| Authorized Official Name | MR. GEORGE GERBER (CONTROLLER) |
| Authorized Official Telephone | 5705316152 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 313M00000X | Nursing Facility/Intermediate Care Facility | 549602 | PA | Nursing & Custodial Care Facilities |
| Y | 314000000X | Skilled Nursing Facility | 549602 | PA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 1007644390010 | 05 | |
| PA | 1007644390002 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982681102 | Bucktail Medical Center | Medicare Defined Swing Bed Unit | 1001 Pine Street, Renovo, PA 17764 | 2005-12-29 |
| 1821083700 | Bucktail Medical Center | General Acute Care Hospital | 1001 Pine St, Renovo, PA 17764-1618 | 2005-09-15 |
| 1710907043 | Bucktail Medical Center | Clinic/Center | 1001 Pine St, Renovo, PA 17764-1618 | 2006-07-20 |
| 1518944735 | Bucktail Medical Center | Ambulance | 1001 Pine Street, Renovo, PA 17764-1618 | 2005-12-29 |
| Street Address |
1001 PINE ST |
| City | RENOVO |
| State | PA |
| Zip Code | 17764-1618 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821083700 | Bucktail Medical Center | General Acute Care Hospital | 1001 Pine St, Renovo, PA 17764-1618 | 2005-09-15 |
| 1679115802 | Eric Baker | Physical Therapy Assistant | 1001 Pine St, Renovo, PA 17764-1620 | 2019-10-09 |
| 1114305703 | Courtney Mason | Physical Therapy Assistant | 1001 Pine St, Renovo, PA 17764-1618 | 2015-05-14 |
| 1669715660 | Pa Rte 120 Inpatient Services, LLC | Emergency Medicine | 1001 Pine St, Renovo, PA 17764-1618 | 2013-03-28 |
| 1356683817 | N Central Pa Emergency Physicians, LLC | Emergency Medicine | 1001 Pine St, Renovo, PA 17764-1618 | 2013-03-22 |
| 1861590523 | Pattijo Edler | Physician Assistant | 1001 Pine St, Renovo, PA 17764-1618 | 2006-09-20 |
| 1710907043 | Bucktail Medical Center | Clinic/Center | 1001 Pine St, Renovo, PA 17764-1618 | 2006-07-20 |
| 1003893272 | Rizalito Advincula | Family Medicine | 1001 Pine St, Bucktail Medical Center, Renovo, PA 17764-1618 | 2005-12-28 |
| 1831188523 | Amanda Mae Jones-sutliff | Physician Assistant | 1001 Pine St, Renovo, PA 17764-1618 | 2005-10-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982681102 | Bucktail Medical Center | Medicare Defined Swing Bed Unit | 1001 Pine Street, Renovo, PA 17764 | 2005-12-29 |
| 1295721272 | Firemens Amb Service Team | Ambulance | 8th and Hurron Ave, Renova, PA 17764 | 2005-09-23 |
| 1518170455 | Western Clinton County Community Services | Community/Behavioral Health | 425 Saint Clair Ave, Renovo, PA 17764-1068 | 2007-05-07 |
| 1982837795 | D&s Haulman Enterprises LLC | Pharmacy | 144 4th St, Renovo, PA 17764-1071 | 2009-08-26 |
| 1669730883 | Adrienne Tripp | Health Educator | 208 10th St, Renovo, PA 17764-1117 | 2012-04-25 |
| 1497116909 | Renovo Fire Department Inc | Ambulance | 230 11th St, Renovo, PA 17764-1121 | 2016-03-10 |
| 1013938059 | Renovo Pharmacy Inc. | Pharmacist | 700 Erie Ave, Renovo, PA 17764-1130 | 2006-07-23 |
| 1942332705 | Robert Louis Stehman Jr. | Pharmacist | 700 Erie Ave, Renovo, PA 17764-1130 | 2007-03-09 |
| 1225209646 | Firemans Ambulance Service Team | Ambulance | 800 Huron Ave, Renovo, PA 17764-1140 | 2008-03-13 |
| 1649438870 | Firemens Ambulance Service Team | Ambulance | 800 Huron Ave, Renovo, PA 17764-1140 | 2008-05-23 |
| Find all providers in zip 17764 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
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| 1851954176 | Silvercare Skilled Nursing LLC | Skilled Nursing Facility | 2600 W 9th St Unit A, Chester, PA 19013-2040 | 2019-04-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.