Provider Demographics
NPI:1235225400
Name:EXCELA HEALTH CONNELLSVILLE INTERNAL MED-DR. TIBERIO
Entity Type:Organization
Organization Name:EXCELA HEALTH CONNELLSVILLE INTERNAL MED-DR. TIBERIO
Other - Org Name:WPHC-TIBERIO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-830-8500
Mailing Address - Street 1:171 W CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-3526
Mailing Address - Country:US
Mailing Address - Phone:724-628-5800
Mailing Address - Fax:724-628-1419
Practice Address - Street 1:171 W CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3526
Practice Address - Country:US
Practice Address - Phone:724-628-5800
Practice Address - Fax:724-628-1419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care