Provider Demographics
NPI:1477743821
Name:TIOGA HEALTH CARE PROVIDERS 11
Entity Type:Organization
Organization Name:TIOGA HEALTH CARE PROVIDERS 11
Other - Org Name:PINE CREEK INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAIBINIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-724-3744
Mailing Address - Street 1:15 MEADE ST
Mailing Address - Street 2:SUITE U4
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1813
Mailing Address - Country:US
Mailing Address - Phone:570-724-3744
Mailing Address - Fax:570-724-2459
Practice Address - Street 1:15 MEADE ST
Practice Address - Street 2:SUITE U4
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1813
Practice Address - Country:US
Practice Address - Phone:570-724-3744
Practice Address - Fax:570-724-2459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAUREL HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty