NPIMap

Organization Active NPI

Charles Cole Memorial Hospital

  • Rural Health Clinic/Center
  • Port Allegany, PA
National Provider Identifier
1760554265
Registry record updated Sep 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CHARLES COLE MEMORIAL HOSPITAL
Practice address
45 N Pine St
Port Allegany, PA 16743-1238
Phone
(814) 642-9655
NPI assigned
Nov 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2025

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

Authorized official

Name
Daniel James Glunk
Title
Interim President
Phone
(570) 321-2284

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

45 N Pine St
Port Allegany, PA 16743-1238

Mailing address

45 N Pine St
Port Allegany, PA 16743-1238
Phone (814) 642-9655

Other identifiers 1

IdentifierTypeStateIssuer
100001127-0072MedicaidPA

Other names 1

  • Port Health Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080728000535 PA Part A Provider - Rural Health Clinic 3779487475 1 other NPI on this enrollment
Practice locations: Port Allegany, PA

Rural health clinic certification: CCN 393988

Legal name
CHARLES COLE MEMORIAL HOSPITAL
Doing business as
PORT HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 26, 1995
Last certification
Dec 11, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Aug 4, 1910 in PA
Enrollment address
45 Pine Street
Port Allegany, PA 16743-1238
Related CCNs
391313

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

Other NPIs with the same Medicare PAC ID 12

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
Tax ID family
Behavioral Health Dept51 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Locations

45 N Pine St
Port Allegany, PA 16743
Phone (814) 642-2505

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 Oct 6, 2014
Maribeth McLaughlin Individual Corporate DirectorBoard Member Mar 1, 2018
Patrick Larsen Individual Corporate DirectorBoard Member Oct 31, 2020
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 100%
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 1, 2020
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.

Facilities with the same owner 63

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 63

Practitioners & affiliated clinicians

Practitioners 67

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 67

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757376000000",
    "number": "1760554265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 N PINE ST",
            "city": "PORT ALLEGANY",
            "state": "PA",
            "postal_code": "167431238",
            "telephone_number": "814-642-9655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 N PINE ST",
            "city": "PORT ALLEGANY",
            "state": "PA",
            "postal_code": "167431238",
            "telephone_number": "814-642-9655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES COLE MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2025-09-09",
        "certification_date": "2025-09-09",
        "status": "A",
        "authorized_official_last_name": "GLUNK",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "INTERIM PRESIDENT",
        "authorized_official_telephone_number": "570-321-2284"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100001127-0072",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port Health Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Port Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Port Allegany, PA

Sources for this page

Verify at the official NPI Registry.