Charles Cole Memorial D/B/a Upmc Cole
Organization Active NPI Ambulatory Surgical Clinic/Center · Coudersport, PA
NPI 1619008554 · NPPES record last updated Nov 6, 2023
Key facts
- NPI
- 1619008554
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulatory Surgical Clinic/Center 261QA1903X
- Legal business name
- CHARLES COLE MEMORIAL D/B/A UPMC COLE
- Practice address
- 1001 E 2ND St
Coudersport, PA 16915-8161 - Phone
- (814) 274-9300
- NPI assigned
- Mar 9, 2007
- Organization subpart
- No
Authorized official
- Name
- Roger C. Yost
- Title
- Cfo
- Phone
- (570) 321-3175
Owners & managing parties with NPI records 3
-
Mary Ann Rigas, MD
-
Vijayant Singh, M.D
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 24
Related certifications (CCN) 13
Practitioners 80
-
Susan M Bennett, CRNP
-
David Charles Brown III, PA-C
-
Breanna Burdick, PA-C
-
Tanya J Chew, PA-C
-
Joshua Jon D'Agostino, PA-C
-
Nicole Dalessandro, DPM
-
Debra Ann Dresser, PA-C
-
Crystal L Fowler, PA-C
-
Donald Ryan Geci, PA-C
-
Kamme Guisto, PA-C
-
Kara Nicole Gustin, WHNP-BC
-
Nicholas Heiser, DO
-
Todd Husson, PA-C
-
Joseph Kaplan, MD
-
Kathleen M Kerr, PA
-
David Jon Krohn, PA
-
Emily A Lynch, PA-C
-
Sunil Parkash, MD
-
Reginald Lyon Reginella, D.O.
-
Emily Rowlands, DO
-
Garrett Michael Russell, PA-C
-
Victoria Lynn Seitzinger, PA-C
-
Leo Sillick, PA-C
Affiliated clinicians 182
-
Darius Abadi, D.O.
-
Jamie L Adam, MD, PHD
-
Alexis Anne Adams, PA-C
-
Gwendolyn Rene Akers, D.O.
-
MHD Said Al Zein, MD
-
Brian Anyanwu, MD
-
Kristine N Ball, CNM
-
Susan M Bennett, CRNP
-
John N. Boll Jr., D.O.
-
David J Borys, MD
-
David Charles Brown III, PA-C
-
Sarah Brown, DO
-
Amanda Budd, CRNP
-
Breanna Burdick, PA-C
-
Jaclyn Rae Cappel, M.D.
-
James M. Clark, M.D.
-
Kristy Nicole Clark, CRNP
-
Peter Edward Cunnius, CRNP
Medicare Care Compare: Hospital
- Listed as
- Upmc Cole
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Hospital certification: CCN 391313
- Legal name
- CHARLES COLE MEMORIAL HOSPITAL
- Doing business as
- UPMC COLE
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Aug 1, 2007
- Last certification
- Mar 3, 2023
- Beds
- 49 (25 certified)
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 4, 1910 in PA
- Enrollment address
- 1001 E 2ND St
Coudersport, PA 16915-8161
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Vijayant Singh |
Corporate Director |
Apr 1, 2025 | |
| Terrance L Foust |
Corporate Director |
Nov 10, 2022 | |
| Matthew Splain |
Corporate Officer |
Nov 11, 2025 | |
| Corporate Director |
Nov 11, 2025 | ||
| Patricia Jackson Gehris |
Corporate Director |
Jun 15, 2022 | |
| Christina Stager |
Corporate Director |
Nov 14, 2024 | |
| Erin E Taylor |
Corporate Director |
Nov 11, 2025 | |
| Patrick Larsen |
Corporate Officer |
Nov 11, 2025 | |
| Corporate Director |
Nov 11, 2025 | ||
| Josh Costa |
Corporate Officer |
Nov 11, 2025 | |
| Corporate Director |
Nov 11, 2025 | ||
| Carrie Ennis |
Corporate Director |
Mar 1, 2018 | |
| Michelle D Jack |
Corporate Director |
Nov 11, 2025 | |
| Ron Reynolds |
Corporate Officer |
Oct 6, 2025 | |
| Corporate Director |
Oct 6, 2025 | ||
| W-2 Managing Employee |
Oct 6, 2025 | ||
| Connie J Perkins |
Corporate Director |
Nov 10, 2022 | |
| Roger C Yost |
Corporate Officer |
Jan 4, 2024 | |
| W-2 Managing Employee |
Jan 4, 2024 | ||
| Upmc |
5% Or Greater Direct Ownership Interest | Mar 1, 2018 | 100% |
| Mary Ann Rigas |
Corporate Officer |
Nov 11, 2025 | |
| Corporate Director |
Nov 11, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070504000079 | PA | Part a Provider - Critical Access Hospital | 3779487475 |
Receives reassigned benefits from 65 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Coudersport, PA; Shinglehouse, PA; Port Allegany, PA |
National Provider Directory
- Tax ID family
- Behavioral Health Dept
Locations
269 Route 6 W
Coudersport, PA 16915
Phone (814) 274-0384
102 S Main St
Coudersport, PA 16915
Phone (814) 274-0384
1001 E 2nd St
Fl 4
Coudersport, PA 16915
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | Yes |
Addresses
Primary practice location
1001 E 2ND St
Coudersport, PA 16915-8161
Mailing address
1001 E 2ND St
Coudersport, PA 16915-8161
Phone (814) 274-9300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1000011270090 | Medicaid | PA |
Other names
- Short Procedure Unit
Other providers in Coudersport, PA
- CCMH Physical Therapy
- CCMH Surgical Specialists
- CCMH Syed Bhat MD
- Celso Luiz Backes, MD, PC
- Charles Cole Mem Home Health HBP
- Charles Cole Memorial Hopstial
- Charles Cole Memorial Hopstial
- Charles Cole Memorial Hospital
- Charles Cole Memorial Hospital
- Charles Cole Memorial Hospital
All providers in Coudersport, PA · Ambulatory Surgical 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 Nov 6, 2023. 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.