Healthcare Provider Details

I. General information

NPI: 1639520760
Provider Name (Legal Business Name): TIOGA HEALTH CARE PROVIDERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 S MAIN ST SUITE
MANSFIELD PA
16933-1510
US

IV. Provider business mailing address

416 S MAIN ST SUITE
MANSFIELD PA
16933-1510
US

V. Phone/Fax

Practice location:
  • Phone: 570-662-0000
  • Fax:
Mailing address:
  • Phone: 570-662-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RONALD M GILBERT JR.
Title or Position: VP FINANCE
Credential:
Phone: 570-723-0603