Provider Demographics
NPI:1972964526
Name:FULTON COUNTY MEDICAL CENTER
Entity type:Organization
Organization Name:FULTON COUNTY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MEZZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-485-6109
Mailing Address - Street 1:214 PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:MC CONNELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17233-8559
Mailing Address - Country:US
Mailing Address - Phone:717-485-6108
Mailing Address - Fax:717-485-6327
Practice Address - Street 1:622 WATER ST
Practice Address - Street 2:
Practice Address - City:ORBISONIA
Practice Address - State:PA
Practice Address - Zip Code:17243-9424
Practice Address - Country:US
Practice Address - Phone:814-447-3062
Practice Address - Fax:814-447-0197
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FULTON COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-10
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA061901261QH0700X, 261QP2000X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine