Healthcare Provider Details

I. General information

NPI: 1043281603
Provider Name (Legal Business Name): TIOGA HEALTH CARE PROVIDERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MEADE ST SUITE L1
WELLSBORO PA
16901-1813
US

IV. Provider business mailing address

22 WALNUT ST
WELLSBORO PA
16901-1526
US

V. Phone/Fax

Practice location:
  • Phone: 570-723-0637
  • Fax: 570-723-0638
Mailing address:
  • Phone: 570-723-0600
  • Fax: 570-724-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD M GILBERT JR.
Title or Position: CFO
Credential:
Phone: 570-723-0600