=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730230871
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TIOGA COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 10/04/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1062 RT 38
-----------------------------------------------------
City | OWEGO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13827-3209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-687-8600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1062 RT 38
-----------------------------------------------------
City | OWEGO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13827-3209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-687-8600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE ACCOUNTING SUPERVISO
-----------------------------------------------------
Name | MS. JANICE M YURICEK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 607-687-8573
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number | 5324200R
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------