MEDICARE: TIOGA HEALTH CARE PROVIDERS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0206X	Mammography Clinic/Center
2	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1639520760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIOGA HEALTH CARE PROVIDERS, INC

Provider Business Mailing Address
First Line	:	416 S MAIN ST
Second Line	:	SUITE
City	:	MANSFIELD
State	:	PA
Zip	:	16933-1510
Country	:	US
Telephone Number	:	570-662-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 S MAIN ST
Second Line	:	SUITE
City	:	MANSFIELD
State	:	PA
Zip	:	16933-1510
Country	:	US
Telephone Number	:	570-662-0000
Fax Number	:

Authorized Official
Title or Position	:	VP FINANCE
Name	:	RONALD M GILBERT JR.
Credential	:
Telephone Number	:	570-723-0603

Provider Enumeration Date	:	06/30/2016
Last Update Date	:	06/30/2016

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