Provider Demographics
NPI:1639520760
Name:TIOGA HEALTH CARE PROVIDERS, INC
Entity Type:Organization
Organization Name:TIOGA HEALTH CARE PROVIDERS, INC
Other - Org Name:SUSQUEHANNA HEALTH MEDICAL PLAZA AT MANSFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
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 1:416 S MAIN ST
Mailing Address - Street 2:SUITE
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933-1510
Mailing Address - Country:US
Mailing Address - Phone:570-662-0000
Mailing Address - Fax:
Practice Address - Street 1:416 S MAIN ST
Practice Address - Street 2:SUITE
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-1510
Practice Address - Country:US
Practice Address - Phone:570-662-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUSQUEHANNA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography