Healthcare Provider Details

I. General information

NPI: 1962841080
Provider Name (Legal Business Name): TIOGA HEALTH CARE PROVIDERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 04/01/2015
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

22 WALNUT ST
WELLSBORO PA
16901-1526
US

V. Phone/Fax

Practice location:
  • Phone: 570-723-7764
  • Fax:
Mailing address:
  • Phone: 570-724-2126
  • Fax: 570-724-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: JANIE M HILFIGER
Title or Position: PRESIDENT
Credential: RN
Phone: 570-723-0100