NPIMap

Organization Active NPI

Tioga Health Care Providers, Inc

Doing business as Susquehanna Health Emergency Svcs at Soldiers and Sailors Mem Hospital

  • Emergency Medicine Physician
  • Wellsboro, PA
National Provider Identifier
1023458882
Registry record updated Mar 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
TIOGA HEALTH CARE PROVIDERS, INC
Doing business as
Susquehanna Health Emergency Svcs at Soldiers and Sailors Mem Hospital
Practice address
32-36 Central Ave
Wellsboro, PA 16901-1840
Phone
(570) 723-0100
NPI assigned
Jun 26, 2013
Last updated
Mar 31, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ronald M Gilbert, JR
Title
Cfo
Phone
(570) 723-0600

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary
Medical Physician Assistant 363AM0700X NU
Nurse Practitioner 363L00000X NU

Addresses

Primary practice location

32-36 Central Ave
Wellsboro, PA 16901-1840

Mailing address

22 Walnut St
Wellsboro, PA 16901-1526
Phone (570) 723-0600

Other names 1

  • Susquehanna Health Emergency Svcs at Soldiers and Sailors Mem Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131024001380 PA Part B Supplier - Clinic/Group Practice 3375597792 Receives reassigned benefits from 18 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wellsboro, PA

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

22 Walnut St
Wellsboro, PA 16901
Phone (570) 723-0621

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427760000000",
    "number": "1023458882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 WALNUT ST",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169011526",
            "telephone_number": "570-723-0600",
            "fax_number": "570-724-2126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32-36 CENTRAL AVE",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169011840",
            "telephone_number": "570-723-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIOGA HEALTH CARE PROVIDERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-26",
        "last_updated": "2015-03-31",
        "status": "A",
        "authorized_official_last_name": "GILBERT",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "570-723-0600",
        "authorized_official_credential": "JR"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susquehanna Health Emergency Svcs at Soldiers and Sailors Mem Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wellsboro, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.