Charles Cole Memorial Hospital
Organization Active NPI Rural Health Clinic/Center · Eldred, PA
NPI 1164594495 · NPPES record last updated Sep 9, 2025
Key facts
- NPI
- 1164594495
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- CHARLES COLE MEMORIAL HOSPITAL
- Practice address
- 139 Main St
Eldred, PA 16731 - Phone
- (814) 225-4241
- NPI assigned
- Nov 14, 2006
- Organization subpart
- No
Authorized official
- Name
- Daniel James Glunk
- Title
- Interim President
- Phone
- (570) 321-2284
Owners & managing parties with NPI records 1
-
Mary Ann Rigas, MD
Other NPIs with the same Medicare PAC ID 12
Corporate family (same tax ID) 24
Related certifications (CCN) 2
Facilities with the same owner 63
Practitioners 67
-
Alexis Anne Adams, PA-C
-
MHD Said Al Zein, MD
-
Kristine N Ball, CNM
-
David Charles Brown III, PA-C
-
Amanda Budd, CRNP
-
Breanna Burdick, PA-C
-
Kristy Nicole Clark, CRNP
-
Peter Edward Cunnius, CRNP
-
William A Flood, MD
-
Crystal L Fowler, PA-C
-
Ethan Gable, M.D.
-
David F Gaieski, MD
-
Lisa R Ganz, CRNA
-
Krystal A Gibbs, CRNA
-
Shivraj Goyal, MD
-
Kamme Guisto, PA-C
-
Kara Nicole Gustin, WHNP-BC
-
Nicholas Heiser, DO
-
Andrea Wilson Heller, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D0699167 | Eldred Health Center | Certificate of waiver | Jun 19, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Rural health clinic certification: CCN 393978
- Legal name
- CHARLES COLE MEMORIAL HOSPITAL
- Doing business as
- ELDRED HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Sep 9, 1993
- Last certification
- Nov 16, 2022
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 4, 1910 in PA
- Enrollment address
- 139 Main St
Eldred, PA 16731-4515 - Related CCNs
- 391313
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Michael Callahan |
Corporate Director |
Oct 1, 2020 | |
| Maribeth McLaughlin |
Corporate Director |
Mar 1, 2018 | |
| Patrick Larsen |
Corporate Director |
Oct 7, 2019 | |
| Josh Costa |
Corporate Director |
Jan 3, 2022 | |
| Carrie Ennis |
Corporate Director |
Mar 1, 2018 | |
| Ron Reynolds |
Corporate Officer |
Oct 6, 2025 | 100% |
| W-2 Managing Employee |
Oct 6, 2025 | 100% | |
| Elizabeth Wallace |
Corporate Officer |
Jan 3, 2022 | |
| Melynda Budd |
Corporate Officer |
Jan 3, 2022 | |
| Alana Huck |
Corporate Officer |
Jan 3, 2022 | |
| Upmc |
5% Or Greater Direct Ownership Interest | Mar 1, 2018 | 100% |
| Mary Ann Rigas |
Corporate Director |
Oct 7, 2019 | |
| John Leete |
Corporate Officer |
Jan 3, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080728000447 | PA | Part a Provider - Rural Health Clinic | 3779487475 | Practice locations: Eldred, PA |
National Provider Directory
- Tax ID family
- Behavioral Health Dept
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
139 Main St
Eldred, PA 16731
Mailing address
1001 E 2ND St
Coudersport, PA 16915-8161
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100001127-0040 | Medicaid | PA |
Other names
- Eldred Health Center
Other providers in Eldred, PA
- Buchanan Brothers Pharmacy Inc
- Eldred Boro Volunteer Fire Department,Inc.
- Abby G Galford
- Kristina Faye Gunsolus
- Amber Karnuth
- Nathan Scott Lowery
All providers in Eldred, PA · Rural Health Clinic/Center in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.