Provider Demographics
NPI:1649328667
Name:TIOGA COUNTY HEALTH DEPT., PSSHSP
Entity type:Organization
Organization Name:TIOGA COUNTY HEALTH DEPT., PSSHSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL ACCT. CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-687-8632
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-0120
Mailing Address - Country:US
Mailing Address - Phone:607-687-8600
Mailing Address - Fax:607-223-7042
Practice Address - Street 1:1062 RTE 38
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-0120
Practice Address - Country:US
Practice Address - Phone:607-687-8632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIOGA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-08
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01457785Medicaid