Provider Demographics
NPI:1306858410
Name:TIOGA HEALTH CARE PROVIDERS, INC. 1
Entity Type:Organization
Organization Name:TIOGA HEALTH CARE PROVIDERS, INC. 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:570-723-0603
Mailing Address - Street 1:25 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1515
Mailing Address - Country:US
Mailing Address - Phone:570-724-6474
Mailing Address - Fax:570-724-1087
Practice Address - Street 1:25 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1515
Practice Address - Country:US
Practice Address - Phone:570-724-6474
Practice Address - Fax:570-724-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT1919509OtherBLUE CROSS/BLUE SHIELD
47832Medicare ID - Type Unspecified