Healthcare Provider Details

I. General information

NPI: 1942218250
Provider Name (Legal Business Name): TIOGA HEALTH CARE PROVIDERS, INC. 5
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32-36 CENTRAL AVE
WELLSBORO PA
16901-1840
US

IV. Provider business mailing address

32-36 CENTRAL AVE
WELLSBORO PA
16901-1840
US

V. Phone/Fax

Practice location:
  • Phone: 570-723-0140
  • Fax: 570-724-6541
Mailing address:
  • Phone: 570-723-0140
  • Fax: 570-724-6541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD M GILBERT JR.
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 570-723-0603