BUCKTAIL MEDICAL CENTER (NPI# 1710907043) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1710907043 |
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 | 2006-07-20 |
Last Update Date | 2016-04-26 |
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 | 261Q00000X | Clinic/Center | 549601 | PA | Ambulatory Health Care Facilities |
Y | 261QC0050X |
Clinic/Center Specialization: Critical Access Hospital |
549601 | PA | Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
PA | 1007644390003 | 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 |
1518944735 | Bucktail Medical Center | Ambulance | 1001 Pine Street, Renovo, PA 17764-1618 | 2005-12-29 |
1093701047 | Bucktail Medical Center | Nursing Facility/Intermediate Care Facility | 1001 Pine St, Renovo, PA 17764-1618 | 2005-09-26 |
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 |
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 |
1093701047 | Bucktail Medical Center | Nursing Facility/Intermediate Care Facility | 1001 Pine St, Renovo, PA 17764-1618 | 2005-09-26 |
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 | 261QC0050X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Critical Access Hospital |
An outpatient entity, facility, or distinct part of a facility within or affiliated with a Critical Access Hospital that provides access to primary care services for individuals in a small rural community and is Medicare certified. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1962754895 | Upmc Wellsboro | Clinic/Center | 32-36 Central Ave, Radiology Department, Wellsboro, PA 16901-1840 | 2012-10-02 |
1730364779 | Tyrone Hospital | Clinic/Center | 2032 E Pleasant Valley Blvd, Altoona, PA 16602 | 2008-01-09 |
1558545376 | Tyrone Hospital | Clinic/Center | 225 Hospital Dr, Tyrone, PA 16686-1802 | 2007-12-28 |
1861530727 | Tyrone Hospital | Clinic/Center | 187 Hospital Dr, Tyrone, PA 16686-1808 | 2007-02-02 |
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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.