Provider Demographics
NPI:1053744706
Name:OLEAN GENERAL HOSPITAL
Entity type:Organization
Organization Name:OLEAN GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-373-2600
Mailing Address - Street 1:122 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MT. JEWETT
Mailing Address - State:PA
Mailing Address - Zip Code:16740
Mailing Address - Country:US
Mailing Address - Phone:814-975-1188
Mailing Address - Fax:
Practice Address - Street 1:122 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MT. JEWETT
Practice Address - State:PA
Practice Address - Zip Code:16740
Practice Address - Country:US
Practice Address - Phone:814-975-1188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA514201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty