BUCKTAIL MEDICAL CENTER (NPI# 1821083700) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821083700 |
| 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 | 2005-09-15 |
| Last Update Date | 2016-02-04 |
| 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 |
|---|---|---|---|---|---|
| Y | 282NC0060X |
General Acute Care Hospital Specialization: Critical Access |
549601 | PA | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 1007644390004 | 05 | |
| PA | 1007644390007 | 05 | |
| PA | 1007644390002 | 05 | |
| PA | 1007644390003 | 05 | |
| PA | 1007644390010 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982681102 | Bucktail Medical Center | Medicare Defined Swing Bed Unit | 1001 Pine Street, Renovo, PA 17764 | 2005-12-29 |
| 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 |
| 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 |
|---|---|---|---|---|
| 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 |
| 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 | 282NC0060X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Critical Access |
| Definition to come. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205207164 | Thomas Jefferson University Hospital | General Acute Care Hospital | 33 Meadow Creek Ln, Glenmoore, PA 19343-2017 | 2015-10-16 |
| 1174860118 | Va Hospital | General Acute Care Hospital | 534 Altoona Pl, Pittsburgh, PA 15228-1204 | 2013-01-10 |
| 1184855330 | Temple Hospital | General Acute Care Hospital | 24 Edgemoor Rd, Cheltenham, PA 19012 | 2009-08-06 |
| 1306004338 | Richard Allen Davis | General Acute Care Hospital | 1238 Meadowbank Rd, Villanova, PA 19085 | 2008-05-27 |
| 1588845663 | York Hospital | General Acute Care Hospital | 2706 Foxshire Dr, York, PA 17402-8531 | 2007-11-17 |
| 1942496179 | Medicare Health Insurance | General Acute Care Hospital | 20 5th St, Claysville, PA 15323-1272 | 2007-09-21 |
| 1780875864 | Pennsylvania | General Acute Care Hospital | 108 Shallow Springs Ct, Exton, PA 19341-3004 | 2007-08-05 |
| 1770620775 | Vaphs | General Acute Care Hospital | 118 Pleasant Dr, Canonsburg, PA 15317-9551 | 2007-01-31 |
| 1609883628 | Va Medical Center | General Acute Care Hospital | 1111 East End Blvd., Wilkes-barre, PA 18711 | 2006-08-02 |
| 1528074911 | Va Medical Center | General Acute Care Hospital | 1111 E. End Blvd, Wilkes-barre, PA 18711 | 2006-07-31 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on BUCKTAIL MEDICAL CENTER.
| 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.