NPIMap

Organization Active NPI

Charles Cole Memorial Hospital

Doing business as Central Potter Health Center

  • Primary Care Clinic/Center
  • Coudersport, PA
National Provider Identifier
1619204641
Registry record updated Nov 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CHARLES COLE MEMORIAL HOSPITAL
Doing business as
Central Potter Health Center
Practice address
71 Elk St
Coudersport, PA 16915-9601
Phone
(814) 274-7070
NPI assigned
Nov 12, 2009
Last updated
Nov 12, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ed Pitchford
Title
Ceo
Phone
(814) 274-9300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

71 Elk St
Coudersport, PA 16915-9601

Mailing address

71 Elk St
Coudersport, PA 16915-9601
Phone (814) 274-7070

Other names 1

  • Central Potter Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100113000734 PA Part A Provider - Rural Health Clinic 3779487475 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coudersport, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619204641. Details of each certification follow.

Rural health clinic certification: CCN 393418

Legal name
CHARLES COLE MEMORIAL HOSPITAL
Doing business as
CENTRAL POTTER HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 21, 2011
Last certification
Aug 22, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Aug 4, 1910 in PA
Enrollment address
71 Elk St
Coudersport, PA 16915-9601
Related CCNs
391313

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

71 Elk St
Coudersport, PA 16915
Phone (814) 274-5577

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Michael Callahan Individual Corporate DirectorBoard Member Mar 1, 2010
Maribeth McLaughlin Individual Corporate DirectorBoard Member Mar 1, 2018
Patrick Larsen Individual Corporate DirectorBoard Member Oct 7, 2019
Josh Costa Individual Corporate DirectorBoard Member Jan 3, 2022
Carrie Ennis Individual Corporate DirectorBoard Member Mar 1, 2018
Ron Reynolds Individual Corporate OfficerPresident Oct 6, 2025 100%
W-2 Managing EmployeeAd; Oct 6, 2025
Elizabeth Wallace Individual Corporate OfficerSecretary Jan 3, 2022
Melynda Budd Individual Corporate OfficerTreasurer Jan 3, 2022
Alana Huck Individual Corporate OfficerVice Chair Jan 3, 2022
Upmc Organization, Pittsburgh, PA Non-profit 5% Or Greater Direct Ownership Interest Mar 1, 2018 100%
Mary Ann Rigas Individual Corporate DirectorBoard Member Oct 7, 2019
John Leete Individual Corporate OfficerChair Jan 3, 2022

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257984000000",
    "number": "1619204641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 ELK ST",
            "city": "COUDERSPORT",
            "state": "PA",
            "postal_code": "169159601",
            "telephone_number": "814-274-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 ELK ST",
            "city": "COUDERSPORT",
            "state": "PA",
            "postal_code": "169159601",
            "telephone_number": "814-274-7070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES COLE MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-12",
        "last_updated": "2009-11-12",
        "status": "A",
        "authorized_official_last_name": "PITCHFORD",
        "authorized_official_first_name": "ED",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "814-274-9300"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Potter Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coudersport, PA

Sources for this page

Verify at the official NPI Registry.