1477743821 NPI number — TIOGA HEALTH CARE PROVIDERS 11

Table of content: (NPI 1477743821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477743821 NPI number — TIOGA HEALTH CARE PROVIDERS 11

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIOGA HEALTH CARE PROVIDERS 11
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477743821
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 MEADE ST
Provider Second Line Business Mailing Address:
SUITE U4
Provider Business Mailing Address City Name:
WELLSBORO
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16901-1813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-724-3744
Provider Business Mailing Address Fax Number:
570-724-2459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 MEADE ST
Provider Second Line Business Practice Location Address:
SUITE U4
Provider Business Practice Location Address City Name:
WELLSBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16901-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-724-3744
Provider Business Practice Location Address Fax Number:
570-724-2459
Provider Enumeration Date:
07/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAIBINIS
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
570-724-3744

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com