Provider Demographics
NPI:1730364779
Name:TYRONE HOSPITAL
Entity type:Organization
Organization Name:TYRONE HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-684-1255
Mailing Address - Street 1:187 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-1808
Mailing Address - Country:US
Mailing Address - Phone:814-684-1255
Mailing Address - Fax:814-684-6398
Practice Address - Street 1:2032 E PLEASANT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602
Practice Address - Country:US
Practice Address - Phone:814-684-3101
Practice Address - Fax:814-684-5539
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TYRONE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QC0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007734000022Medicaid